The SAMe-TT2R2 score and decision-making between a Vitamin K Antagonist or a Non-Vitamin K Antagonist Oral Anticoagulant in patients with atrial fibrillation

Oral anticoagulation therapy is essential in patients with atrial fibrillation and clinicians need guidance on decision-making between the vitamin K antagonists (VKA), e.g. warfarin, or non-vitamin K antagonist oral anticoagulants. Observational studies have shown that patients who receive VKA therapy spend a significant percentage of their time with INR values outside of the therapeutic range (time in therapeutic range, TTR <60%.) Recently, a clinical score has been developed with commonly-encountered clinical features, the SAMe-TT2R2 score, to help decision-making with regards to whether a patient is likely to do well, or not, with a VKA. Those with a SAMe-TT2R2 score 0-1 are likely to do well on a VKA, whilst those with a SAMe-TT2R2 score ≥2 are on probability going to achieve suboptimal TTR. In this article, we provide an overview of the main published retrospective and prospective studies that have validated the SAMe-TT2R2 score and its value for decision-making in daily clinical practice.