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Clinical usefulness of the SAMe-TT2R2 score: A systematic review and simulation meta-analysis

van Miert, J. H. A., Bos, S., Veeger, N. J. G. M. & Meijer, K., 13-Mar-2018, In : PLoS ONE. 13, 3, 13 p., e0194208.

Research output: Contribution to journalArticleAcademicpeer-review

BACKGROUND: Vitamin K antagonist (VKA) therapy is safer and more effective when patients have a high time within the therapeutic range and low international normalised ratio variability. The SAMe-TT2R2 score aims to identify those at risk for poor VKA control.

OBJECTIVES: To evaluate the predictive value and clinical usefulness of the SAMe-TT2R2 score to identify those at risk for poor VKA control.

METHODS: We performed a systematic review in MEDLINE and Embase for original research papers assessing the SAMe-TT2R2's relation to poor TTR. We performed a meta-analysis where scores ≥ 2 and ≥ 3 predicting TTR < 70%. When studies evaluated other cutoffs for TTR or SAMe-TT2R2, they were harmonised by multiple simulations with patient characteristics from the individual studies, if the data were available.

RESULTS: 16 studies were identified and used in the meta-analysis: 4 and 2 times directly, 8 and 8 times harmonised for scores ≥ 2 and ≥ 3, respectively (not all studies provided information about both cutoffs). The sensitivities and specificities were too heterogeneous to pool. The positive likelihood ratios were 1.25 (1.14-1.38) for a score ≥ 2, and 1.24 (1.09-1.40) for a score ≥ 3; the negative ones were 0.87 (0.82-0.93) and 0.96 (0.91-1.02), respectively. This shows that the post-test probabilities hardly differ from the prior probability (prevalence).

CONCLUSION: The SAMe-TT2R2 score does predict low TTR, but the effect is small. Its effect on individual patients is too limited to be clinically useful.

Original languageEnglish
Article numbere0194208
Number of pages13
JournalPLoS ONE
Volume13
Issue number3
Publication statusPublished - 13-Mar-2018

    Keywords

  • Journal Article, predicts, time, warfarin, quality, HEART-DISEASE, INCEPTION COHORT, THERAPEUTIC RANGE, ORAL ANTICOAGULATION CONTROL, NONVALVULAR ATRIAL-FIBRILLATION, VITAMIN-K ANTAGONISTS

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