The Quality Of Warfarin Anticoagulation And Its Relationship With SAMe-TT₂R₂ Score In Patients With Atrial Fibrillation

BackgroundWarfarin can reduce the risk of thrombosis in patients with atrial fibrillation and is economical.However,it is influenced by many factors,patients need to monitor the international standardized ratio(INR),and the time in therapeutic range(TTR)should be kept at least 65%.The new oral anticoagulants eliminate this test with higher safety,but they are at a high price and not suitable for patients with valvular atrial fibrillation.Warfarin still play an important role in anticoagulant therapy and the quality of anticoagulation is associated with patients'health directly.In 2013,some scholars put forward the SAMe-TT2R2 score which can predict the quality of warfarin anticoagulation.Patients with SAMe-TT2R2<2 would have good anticoagulation quality when taking warfarin,while patients with SAMe-TT2R2?2 are unlikely to obtain good anticoagulation quality,requiring further intervention.Currently,there are few studies on the SAMe-TT2R2 score in non-white people,and the applicability of this score in non-white people needs more studies.At the same time,in the context of low anticoagulation quality of patients with atrial fibrillation and the world's highest lifetime risk of stroke in China,it is of great importance to improve the quality of anticoagulation to prevent thrombosis,and we will carry out relevant studies on this.Objectives1.To find factors influencing the quality of warfarin anticoagulation in patients with atrial fibrillation,helping to provide information for improving the quality of anticoagulation.2.To explore the value of SAMe?TT2R2 score in predicting the quality of warfarin anticoagulation,and its relationship with adverse events,helping to provide reference for anticoagulation decision-making and management of atrial fibrillation.MethodsBy convenient sampling,patients with atrial fibrillation who received warfarin anticoagulant therapy in a third-grade hospital from January 2015 to February 2018 were selected for the SAMe-TT2R2 score and follow-up.General information,INR,thromboembolism,bleeding and all-cause death were collected through electronic medical records,telephone and outpatient visits et al.The study end at August 2018.Logistic regression was used to find factors associated with the quality of anticoagulation.Area under the receiver operating characteristic curve(AUC)was used to assess the ability of SAMe-TT2R2 score to predict anticoagulation control.Survival analysis was used to explore the relationship between SAMe-TT2R2 score and adverse events.Results1.A total of 261 patients were included with an average age of 63.2±10.9 years.The median TTR was just 30.1%(10.9%,52.0%),only 12.3%of the cohorts got a high quality of warfarin control(TTR>65%).Age<60 years and previous stroke were associated with poor anticoagulation independently;the influence of gender,smoking and INR monitoring compliance on anticoagulant quality remains to be studied.We found no relationship between different quality of anticoagulation and adverse events,but patients with TTR<65%were more likely to suffer adverse events.2.SAMe-TT2R2>3 score was effective to predict low quality of anticoagulation although modestly,AUC=0.637,95%CI(0.575-0.695),P =0.002,the sensitivity and specificity were 53.7%and 68.8%,respectively.No difference was found between SAMe-TT2R2?3 vs.>3 in ischemic stroke,bleeding and all-cause death,but in the proportion of compound adverse events,patients with SAMe-TT2R2?3 were significantly lower than those with SAMe-TT2R2>3(4.7%vs.12.0%),RR=0.390,95%CI(0.157-0.964),P = 0.033.ConclusionThe quality of warfarin anticoagulation in patients with atrial fibrillation is poor,far lower than the effective anticoagulant level.Age<60 years and previous stroke were the influencing factors of low quality of warfarin anticoagulation.The SAMe-TT2R2 score has modest predictive value for anticoagulation quality.Patients with SAMe-TT2R2>3 have poor warfarin anticoagulation and a higher incidence of compound adverse events.Medical staff should take measures to strengthen anticoagulant management for patients with age<60 years,previous stroke and SAMe-TT2R2>3,so as to improve the quality of anticoagulation and prevent stroke.