Assessing the Predictive Value of the SAMe-TT2R2 Score for Poor Anticoagulation Control in a Diverse Ethnic Population

Introduction: In Asian countries, warfarin is still widely used for stroke prevention in non-valvular atrial fibrillation compared to non-vitamin K antagonist oral anticoagulants (NOACs) due to its affordability. A tool such as the SAMe-TT2R2 is needed to determine the probability of achieving and maintaining good anticoagulation control with warfarin therapy. However, it requires validation in the Malaysian cohort. Therefore, the objective of our study is to validate the SAMe-TT2R2 score in predicting poor anticoagulation control in Malaysia. A time in therapeutic range (TTR) 5 best predicts poor anticoagulation control with a sensitivity of 0.49 and a specificity value of 0.68. Conclusion: The SAMe-TT2R2 score, especially when exceeding 5, was associated with a higher likelihood of poor anticoagulation control, emphasizing its relevance in clinical assessment. However, its limited predictive capability, reflected by a C-statistic of 0.548, suggests the need for cautious interpretation and consideration of additional factors in anticoagulation management decisions. Continuous monitoring and personalized strategies are crucial for optimizing outcomes in this population.