SAMe-TT 2 R 2 to Predict Clinical Outcomes and Time in Therapeutic Range in Patients on Vitamin K Antagonists: A Systematic Review and Meta-Analysis.

Autor: Incomenoy S; Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand., Saokaew S; Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand., Poonchuay N; Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand.; Drug and Cosmetics Excellence Center, Walailak University, Nakhon Si Thammarat, Thailand.
Jazyk: angličtina
Zdroj: The Annals of pharmacotherapy [Ann Pharmacother] 2024 Feb; Vol. 58 (2), pp. 126-139. Date of Electronic Publication: 2023 Apr 26.
DOI: 10.1177/10600280231166643
Abstrakt: Background: The SAMe-TT 2 R 2 score identifies patients on vitamin K antagonists (VKAs) who are more likely to have poor time in therapeutic range (TTR); however, the association between SAMe-TT 2 R 2 and clinical outcomes remains controversial.
Objectives: The objective is to assess the association of SAMe-TT 2 R 2 score with clinical outcomes and poor TTR in patients on VKAs.
Methods: We searched using the term "SAMe-TT 2 R 2 ." Original articles reporting clinical outcomes and SAMe-TT 2 R 2 scores before October 2021 were included. Odds ratios (ORs) of clinical outcomes, diagnostic accuracy parameters of poor TTR (<60%-70%), and mean TTR were extracted. Meta-analysis was performed using random-effects models.
Results: Ten studies were included (N = 22 894); 4 showed pooled changes in TTR of -3.61% (95% CI:-4.88% to -2.35%) and -3.98% (95% CI: -6.08% to -1.87%) at SAMe-TT 2 R 2 scores ≥2 and ≥3, respectively, compared with lower scores. The diagnostic accuracy parameters for poor TTR were too heterogeneous to conclude. SAMe-TT 2 R 2 ≥3 significantly correlated with all adverse events (OR = 1.43 [95% CI: 1.29-1.54; P < 0.001]), composite thromboembolism (OR = 1.53 [95% CI: 1.19-1.97; P = 0.001]), and composite bleeding (OR = 1.33 [95% CI: 1.12-1.59; P = 0.001] regardless of the indication, while an SAMe-TT 2 R 2 ≥2 significantly correlated with mortality (OR = 1.32 [95% CI: 1.02-1.70; P = 0.033]). We found no relationship between an SAMe-TT 2 R 2 ≥3 and mortality or between a score ≥2 and clinical outcomes.
Conclusions and Relevance: Patients on VKAs with SAMe-TT 2 R 2 ≥3 experienced more adverse events, bleeding, and thromboembolism compared with patients who had an SAMe-TT 2 R 2 <3. However, the score had limited and inconclusive predictability for poor TTR in the study.
Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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