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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, December 20, 2015

SAMe-TT2R2 score

The SAMe-TT2R2 score is to aid decision making between a non-VKA oral anticoagulant (NOAC) and a vitamin K antagonist (VKA)
"Decisions on rate and rhythm control are determined by patient symptoms. Given that atrial fibrillation (AF) commonly coexists with various comorbidities, attention to cardiovascular risk factors and so-called ‘upstream therapy’ should be part of the holistic approach to AF management.
As part of the management cascade, stroke prevention is the main priority. The major guidelines (European, American, NICE) all now recommend use of a risk factor based approach, with the CHA2DS2-VASc score.
The 2012 ESC and 2014 NICE guidelines recommends a clinical practice shift towards initial focus on identification of ‘truly low-risk’ patients with AF [STEP 1], that is, those patients who with a CHA2DS2-VASc score=0 (male) or 1 (female), who do not need any antithrombotic therapy. Subsequent to this [STEP 2], patients with AF and ≥1 stroke risk factors can be offered effective stroke prevention, which is oral anticoagulation. Oral anticoagulation can be offered as a non-vitamin K antagonist oral anticoagulant (NOAC) or 
a vitamin K antagonist (eg warfarin) with good quality anticoagulation control as reflected by a time in therapeutic range (TTR) >65–70%.
In a newly diagnosed non-anticoagulated AF patient, decision making between a NOAC and a VKA can be made using the SAMe-TT2R2 score. This is a simple score based on clinical factors that helps discriminate those patients who would do well on a VKA (with a TTR>65%), if SAMe-TT2R2 score 0-2. If the SAMe-TT2R2 is >2, the patient is less likely to achieve a good TTR and alternative strategies (e.g. a NOAC) should be used rather than subject the patient to a 'trial of warfarin' that may expose the patient to stroke and thromboembolism."
Calculator developed from the SAMe-TT2R2 score. 
© 2015 Royal College of Physicians of Edinburgh