Evaluation And Application Of The SAMe-TT₂R₂ Score In The Anticoagulation Effect Of Patients With Non-valvular Atrial Fibrillation

Objective:By collecting clinical data of patients with non-valvular atrial fibrillation using warfarin anticoagulation,to understand the distribution of patients with atrial fibrillation in our hospital in the SAMe-TT₂R₂ scoring system and the quality of anticoagulation;analysis of nonvalvular AF with warfarin anticoagulation Influencing factors of anticoagulant quality in patients,explore the predictive effect of SAMe-TT₂R₂ score on anticoagulant quality of warfarin.Methods:Patients who were hospitalized in the First Affiliated Hospital of Shihezi University School of Medicine from January 2018 to January 2019 and were diagnosed with nonvalvular atrial fibrillation with oral warfarin anticoagulation and followed up regularly were taken as observation objects for a 10-month follow-up.Collecting the general situation of patients,the international standardized ratio?INR?,the occurrence of adverse events such as new ischemic stroke,bleeding and all-cause death through the main methods such as inpatient electronic medical records,outpatient inspection system,telephone follow-up,and understand the distribution of patients Situation,analysis of influencing factors of warfarin anticoagulant quality and evaluation of the ability of SAMe-TT₂R₂ score to predict anticoagulant efficacy in patients.Results:1.Basic information:A total of 190 patients were included in this study,with an average age of70.56±10.52 years;113 males and 77 females;the dose of warfarin was 2.44±0.93 mg;the underlying diseases mainly include coronary 109 cases of heart disease/myocardial infarction?55.8%?,96 cases of hypertension?50.5%?,62 cases of congestive heart failure?29.5%?,etc;concurrently used drugs include 94cases of beta blockers?49.5%?,93 cases of statins?48.9%?,66 cases of ARB/ACEI?34.7%?,33 cases of calcium antagonists?17.4%?,etc;13 patients?6.8%?with a history of smoking within 2 years;review INR interval 65 cases were less than 1 month,104 cases were separated from 1 month to 2 months,21 cases were separated from 2 months to 3 months.2.Distribution of SAMe-TT₂R₂ score and anticoagulation quality:TTR?65%?high quality anticoagulation?in 44 cases?23.2%?,and TTR<65%?low quality anticoagulation?in 146 cases?76.8%?.14 cases with SAMe-TT₂R₂score?2 points,and 176 cases with SAMe-TT₂R₂score>2 points,the lowest TTR score was 2 points,the highest score was 7 points.Grouping statistics were performed according to the SAMe-TT₂R₂ score,and the actual anticoagulant quality of each group was observed.9 cases with the actual high anticoagulant quality were observed in the score?2 points,the actual high anticoagulant quality accounted for 64.3%of the estimated value.141 cases with low anticoagulant quality were observed in the score>2 points,the actual low anticoagulant quality accounted for 80.1%of the estimated value.3.The incidence of new stroke events,bleeding events,all-cause death events and compound adverse events:5 patients?2.6%?had new ischemic stroke events.Bleeding events occurred in 25 cases?13.1%?,among which 24 cases were minor bleeding events,which did not lead to drug discontinuation,and 1 case was cerebral hemorrhage leading to death.All-cause deaths occurred in 11 cases?5.8%?,compound adverse events occurred in 36 cases?18.9%?.According to the current statistical distribution of anticoagulant quality stratification in patients,there were no statistically significant differences in the occurrence of bleeding events,new stroke events,all-cause deaths and compound adverse events between the TTR?65%group and the TTR<65%group.According to the analysis of the distribution of the SAMe-TT₂R₂score,there were no statistically significant differences in the occurrence of bleeding events,new stroke events,all-cause deaths and compound adverse events between the SAMe-TT₂R₂ score?2 group and the SAMe-TT₂R₂ score>2 group.4.The influencing factors of anticoagulation quality:the results of univariate analysis showed that the proportion of patients with TTR<65%was significantly higher than that with TTR?65%in patients over60 years old,previous history of stroke,heart failure,the basic diseases greater than 2,combined use of digoxin,?-blocker or ACEI/ARB drugs?P<0.05?,and the difference was statistically significant.Multivariate analysis showed that age under 60 years of age,previous history of stroke and history of heart failure were independent risk factors for anticoagulant quality?P<0.05?.5.The predictive effect of SAMe-TT₂R₂ score on anticoagulant quality:the average TTR of all patients was 46.76%±21.99%.The score of SAMe-TT₂R₂ was negatively correlated with the TTR of patients,and the correlation index was-0.299?P<0.001?.The predictive power of the SAMe-TT₂R₂ score for TTR<65%was analyzed according to the ROC curve,the area under the ROC curve was AUC=0.661,P=0.001,The critical value corresponding was 4 points,and the sensitivity and specificity were 72.6%and 47.7%.Conclusion:1.Among the patients with non-valvular atrial fibrillation who received warfarin anticoagulation,most of the patients had TTR<65%,and the anticoagulation quality was poor.2.According to the analysis of the rating system of SAMe-TT₂R₂,the lowest score of the patients in our country is 2 points,and the score of most patients is relatively high.3.Age,history of stroke and heart failure were independent risk factors for warfarin anticoagulant quality.The score of SAMe-TT₂R₂ had certain predictive power for the low anticoagulant quality of patients treated with warfarin anticoagulation,but the optimal critical value was 4 points.