Clinical usefulness of the SAMe-TT2R2 score: A systematic review and simulation meta-analysisvan 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 journal › Article › Academic › peer-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.
|Number of pages||13|
|Publication status||Published - 13-Mar-2018|
- Journal Article, predicts, time, warfarin, quality, HEART-DISEASE, INCEPTION COHORT, THERAPEUTIC RANGE, ORAL ANTICOAGULATION CONTROL, NONVALVULAR ATRIAL-FIBRILLATION, VITAMIN-K ANTAGONISTS