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Vol. 69. Issue 8.
Pages 799 (August 2016)
Letter to the Editor
DOI: 10.1016/j.rec.2016.04.026
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SAMe-TT2R2 Score: Useful in All Patients With Nonvalvular Atrial Fibrillation? Response
Puntuación SAMe-TT2R2: ¿es útil en todos los pacientes con fibrilación auricular no valvular? Respuesta
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José M. Andreu-Cayuelasa, Carmen M. Pucheb, Pedro J. Flores-Blancoa, Sergio Manzano-Fernándeza,c,
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a Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Arrixaca-IMIB, El Palmar, Murcia, Spain
b Laboratorio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
c Departamento de Medicina Interna, Universidad de Murcia, Facultad de Medicina, Murcia, Spain
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Rev Esp Cardiol. 2016;69:79810.1016/j.rec.2016.04.018
Carlos Escobar, Vivencio Barrios, José María Lobos, Luis Prieto
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To the Editor,

We appreciate the comments of Escobar et al1 regarding our article.1 The introduction of alternatives to vitamin K antagonists (VKA) has demonstrated the importance of the early identification of patients who are most likely to exhibit poor International Normalized Ratio (INR) control.

The SAMe-TT2R2 score has been proposed as a predictor of poor anticoagulation control.2 Although it has been validated in a number of populations of patients with atrial fibrillation, this score could still be improved, as the C-statistic reported in these studies is low (0.55-0.6).3 Moreover, our results indicate that it is less useful in patients in unstable situations, such as recent decompensated heart failure.1

Factors such as a history of bleeding, multidrug therapy, and eating habits appear to show promise in terms of improving the predictive capacity of new scores that will better distinguish those patients who are less suitable to receive VKA.3 Other factors—such as abuse of alcohol or other drugs, chronic kidney disease, cancer, mental disorders,4 and even the experience of the physician adjusting the VKA dose—have also been shown to be capable of predicting an inadequate percentage of time in therapeutic range.5

However, although new scoring systems will probably enhance our capacity to predict poor INR control, they should not involve a degree of complexity that would limit their use in routine clinical practice, unless they offer a significant improvement.

References
[1]
J.M. Andreu-Cayuelas, C.M. Puche, C. Caro-Martínez, P.J. Flores-Blanco, M. Valdés, S. Manzano-Fernández.
La puntuación SAMe-TT2R2 no predice el tiempo en rango terapéutico tras un ingreso por insuficiencia cardiaca aguda en pacientes con fibrilación auricular.
Rev Esp Cardiol., 69 (2016), pp. 453-454
[2]
S. Apostolakis, R.M. Sullivan, B. Olshansky, G.Y. Lip.
Factors affecting quality of anticoagulation control amongst atrial fibrillation patients on warfarin: the SAMe-TT2R2 score.
Chest., 144 (2013), pp. 1555-1563
[3]
J.M. Lobos-Bejarano, V. Barrios-Alonso, J. Polo-García, C. Escobar-Cervantes, D. Vargas-Ortega, N. Marín-Montañés, et al.
Evaluation of SAMe-TT2R2 score and other clinical factors influencing the quality of anticoagulation therapy in non-valvular atrial fibrillation: a nationwide study in Spain.
Curr Med Res Opin., (2016),
[4]
A.J. Rose, E.M. Hylek, A. Ozonoff, A.S. Ash, J.I. Reisman, D.R. Berlowitz.
Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA).
J Thromb Haemost., 8 (2010), pp. 2182-2191
[5]
J.S. Dlott, R.A. George, X. Huang, M. Odeh, H.W. Kaufman, J. Ansell, et al.
National assessment of warfarin anticoagulation therapy for stroke prevention in atrial fibrillation.
Circulation., 129 (2014), pp. 1407-1414
Copyright © 2016. Sociedad Española de Cardiología
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