Nijole Bernaitis1, Chi Keong Ching2, Liping Chen3, Jin Shing Hon3, Siew Chong Teo3, Andrew K Davey1, Shailendra Anoopkumar-Dukie4. 1. Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Pharmacy, Griffith University, Queensland, Australia. 2. Cardiology Department, National Heart Centre Singapore, Singapore. 3. Pharmacy Department, National Heart Centre Singapore, Singapore. 4. Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Pharmacy, Griffith University, Queensland, Australia. Electronic address: s.dukie@griffith.edu.au.
Abstract
BACKGROUND: Warfarin reduces stroke risk in atrial fibrillation (AF) patients but requires ongoing monitoring. Time in therapeutic range (TTR) is used as a measure of warfarin control, with a TTR less than 60% associated with adverse patient outcomes. The Sex, Age, Medical history, Treatment, Tobacco use, Race (SAMe-TT2R2) score has been identified as a model able to predict warfarin control, but this has been tested in mainly Caucasian populations. Therefore, the aim of this study was to determine the ability of the SAMe-TT2R2 score to predict warfarin control in a Singaporean population consisting of Chinese, Malay, and Indian race. METHODS: Retrospective data were collected from the National Heart Centre Singapore for AF patients receiving warfarin between January and June 2014. The TTR and the SAMe-TT2R2 score were calculated for each patient. RESULTS: The 1137 non-valvular AF patients had a mean TTR of 58.0 ± 34.3% and a median SAMe-TT2R2 score of 3. The categorized SAMe-TT2R2 scores (2 versus >2) showed a significant reduction in mean TTR for the entire population (63.2% versus 55.8%, P = .0004) and also when categorized according to race for Chinese (62.7% versus 56.9%, P = .0075) and Malay (68.4% versus 50.6%, P = .0131) populations. CONCLUSION: The SAMe-TT2R2 tool is effective in predicting warfarin control in a Singaporean population as patients with a score greater than 2 had poor control. The minimum score for non-Caucasian patients is 2; thus, in these patients, the presence of any additional risk factors identified in the SAMe-TT2R2 tool categorizes them as unlikely to achieve adequate warfarin control and possible candidates for alternative anticoagulants.
BACKGROUND:Warfarin reduces stroke risk in atrial fibrillation (AF) patients but requires ongoing monitoring. Time in therapeutic range (TTR) is used as a measure of warfarin control, with a TTR less than 60% associated with adverse patient outcomes. The Sex, Age, Medical history, Treatment, Tobacco use, Race (SAMe-TT2R2) score has been identified as a model able to predict warfarin control, but this has been tested in mainly Caucasian populations. Therefore, the aim of this study was to determine the ability of the SAMe-TT2R2 score to predict warfarin control in a Singaporean population consisting of Chinese, Malay, and Indian race. METHODS: Retrospective data were collected from the National Heart Centre Singapore for AFpatients receiving warfarin between January and June 2014. The TTR and the SAMe-TT2R2 score were calculated for each patient. RESULTS: The 1137 non-valvular AFpatients had a mean TTR of 58.0 ± 34.3% and a median SAMe-TT2R2 score of 3. The categorized SAMe-TT2R2 scores (2 versus >2) showed a significant reduction in mean TTR for the entire population (63.2% versus 55.8%, P = .0004) and also when categorized according to race for Chinese (62.7% versus 56.9%, P = .0075) and Malay (68.4% versus 50.6%, P = .0131) populations. CONCLUSION: The SAMe-TT2R2 tool is effective in predicting warfarin control in a Singaporean population as patients with a score greater than 2 had poor control. The minimum score for non-Caucasian patients is 2; thus, in these patients, the presence of any additional risk factors identified in the SAMe-TT2R2 tool categorizes them as unlikely to achieve adequate warfarin control and possible candidates for alternative anticoagulants.
Authors: Arintaya Phrommintikul; Surakit Nathisuwan; Siriluck Gunaparn; Rungroj Krittayaphong; Wanwarang Wongcharoen; Sukhi Sehmi; Samir Mehta; Neil Winkles; Peter Brocklehurst; Jonathan Mathers; Sue Jowett; Kate Jolly; Deirdre Lane; G Neil Thomas; Gregory Y H Lip Journal: BMJ Open Date: 2021-10-11 Impact factor: 2.692
Authors: Eman Nawash Alhmoud; Hazem Elewa; Mohammed S Abdul Gelil; Osama B Abd El Samad; Abdelnasser Y Elzouki Journal: Clin Appl Thromb Hemost Date: 2020 Jan-Dec Impact factor: 2.389