IJCS | Volume 31, Nº5, September / October 2018

DOI: 10.5935/2359-4802.20180044 483 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2018;31(5)483-491 Mailing Address: Fernando Pivatto Júnior Rua Ramiro Barcelos, 2.350, sala 700. Postal Code: 90.035-903. Porto Alegre, RS - Brazil. E-mail: fpivatto@gmail.com SAMe-TT 2 R 2 Score: A Useful Tool in Oral Anticoagulation Decision-Making for Venous Thromboembolism Patients? Fernando Pivatto Júnior, Rafaela Fenalti Salla, Lísia Cunha Cé, Andréia Biolo, André Luís Ferreira Azeredo da Silva, Bruno Führ, Luís Carlos Amon, Marina Bergamini Blaya, Rafael Selbach Scheffel Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS - Brazil Manuscript received August 30, 2017; reviewed December 12, 2017; accepted January 16, 2018. Abstract Background: The SAMe-TT 2 R 2 score was introduced to identify atrial fibrillation patients with a high risk of not achieving a good time in therapeutic range (TTR) during vitamin K antagonists (VKA) therapy. Objective: The aim of this study was to evaluate this score in venous thromboembolism (VTE) patients. Patients and methods: A retrospective cohort study of patients receiving care at the outpatient anticoagulation clinic of a tertiary care teaching hospital. Patients were classified as having low (score 0-1) or high risk (score ≥ 2) of not achieving a good TTR. The area under the ROC curve was calculated to assess the ability of the score to predict a TTR ≥ 65%. Adverse event-free survival curves according to the SAMe-TT 2 R 2 score were calculated by the Kaplan-Meier method and compared by the log-rank test. A p-value < 0.05 was considered statistically significant. Results: We investigated 111 patients during a median follow-up of 2.3 (0.7-6.4) years. Mean age was 54.1 ± 15.7 years and 71 (64.0%) were women. Low- and high-risk groups had similar mean TTR (51.9 vs. 49.6%; p = 0.593). The two groups did not differ significantly in the percentage of patients achieving a TTR ≥ 65% (35.6 vs. 25.8%; p = 0.370). The c-statistic was 0.595 (p = 0.113) for TTR ≥ 65%. Adverse event-free survival during anticoagulation was also similar in both groups (p = 0.136). Conclusions: The SAMe-TT 2 R 2 score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting. (Int J Cardiovasc Sci. 2018;31(5)483-491) Keywords: Venous thrombosis; Venous thromboembolism; Pulmonary embolism; Anticoagulants; Decision support techniques. Introduction Deep vein thrombosis (DVT) and pulmonary embolism (PE) are clinical manifestations of the same pathological process, collectively termed venous thromboembolism (VTE), which is the third most common cardiovascular condition after myocardial infarction and stroke, with an estimated incidence rate of 0.7-2.0 per 1,000 person-years. 1 Another important feature of the disease is the high mortality rate associated with PE. In Brazil, PE accounted for 0.05% of total hospital admissions (46,421 of 89,499,700) from 2008 to 2015, with a mortality rate of 21.4%. 2 In a Canadian study including 67,354 definite and 35,123 probable cases of VTE, the 30-day and 1-year case- fatality rates after definite or probable VTE were 10.6 and 23.0%, respectively. 1 One-quarter to one-third of acute episodes of VTE are recurrences, 3 and VTE has been recognized as a chronic disease associated with short- and long-term morbidity and mortality. 4 Therefore, the management of VTE requires recurrence prevention, often through prolonged anticoagulant treatment, which has been traditionally performed using vitamin K antagonists (VKA), but now can be performed with the use of novel anticoagulants (NOAC). The efficacy and safety of VKA treatment are