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Abstract
Objective
The sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) Score; the sex, age, medical history, treatment, tobacco use, genotype combination (SAMe-TT2G2) Score; and the so-called modified SAMe-TT2R2 scores have been proposed to predict the anticoagulation quality for patients with non-valvular atrial fibrillation (NVAF). The data from a prospective controlled study is used to validate the SAMe-TT2R2 and SAMe-TT2G2 scores in Chinese NVAF patients treated with warfarin and to evaluate the association of factors with time in therapeutic range (TTR) to predict the quality of oral anticoagulation control.
Methods
A total of 379 patients with NVAF under warfarin treatment for a three-month follow-up were included in this prospective, multicenter study. The quality of oral anticoagulation control was evaluated by the TTR. The TTR was dichotomized for binary logistic regression analysis, using a cutoff point for classification as an inadequate (TTR < 65.0%) control.
Results
The 379 NVAF patients had a mean TTR of 58.35 ± 26.33% and median SAMe-TT2R2 and SAMe-TT2G2 scores of 3 and 2, respectively. The discrimination performances of the SAMe-TT2R2 and SAMe-TT2G2 scores for inadequate anticoagulation control (TTR < 65.0%) were poor (c-index < 0.60). The gene frequency of CYP2C9*3 was 3.2% and that of VKORC1-1639 G > A was 89.3%. Genetic variation of CYP2C9*3 and VKORC1-1639 G > A did not affect TTR after initial treatment. The condition TTR < 65.0% was associated with an age below 60 without genotype-guided warfarin dose initiation and concomitant torasemide.
Conclusions
A warfarin-dosing algorithm used for initial treatment of patients older than 60 helps to achieve a better quality of oral anticoagulation control, whereas concomitant torasemide can produce a negative effect. These findings provide useful information for future investigations on the quality of oral anticoagulation control in Chinese anticoagulation clinical practice.
Acknowledgements
No assistance in the preparation of this article is to be declared.
Transparency
Declaration of funding
This work was supported by National Major New Drug Creation Project of China (No. 2020ZX09201-010), Health Department Foundation of Hunan Province (No. 20201656), the New Xiangya Talent Projects of the Third Xiangya Hospital of Central South University (No. JY201616) and the Fundamental Research Funds for the Central Universities of Central South University (No. 1053320190867).
Declaration of financial/other relationships
All authors have nothing to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
All authors participated in the design and analysis of the study and contributed to the manuscript development. YL: data analysis and article writing; JY: genetic testing and data analysis; YK: scheme design; CW: statistical methods and scientific advice; LY, QF: data analysis and scientific advice; QP: article manuscript review; GY: quality supervision. All authors gave final approval of the version to be published.