Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China.
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.
Curr Med Res Opin. 2020 Sep;36(9):1433-1439. doi: 10.1080/03007995.2020.1796611. Epub 2020 Jul 28.
The sex, age, medical history, treatment, tobacco use, race risk (SAMe-TTR) Score; the sex, age, medical history, treatment, tobacco use, genotype combination (SAMe-TTG) Score; and the so-called modified SAMe-TTR 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-TTR and SAMe-TTG 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.
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.
The 379 NVAF patients had a mean TTR of 58.35 ± 26.33% and median SAMe-TTR and SAMe-TTG scores of 3 and 2, respectively. The discrimination performances of the SAMe-TTR and SAMe-TTG scores for inadequate anticoagulation control (TTR < 65.0%) were poor (c-index < 0.60). The gene frequency of was 3.2% and that of was 89.3%. Genetic variation of and 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.
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.
提出了性别、年龄、既往史、治疗方法、吸烟史、种族风险（SAMe-TTR）评分、性别、年龄、既往史、治疗方法、吸烟史、基因型组合（SAMe-TTG）评分以及所谓的改良 SAMe-TTR 评分，以预测非瓣膜性心房颤动（NVAF）患者的抗凝治疗质量。本研究使用前瞻性对照研究的数据，对接受华法林治疗的中国 NVAF 患者进行 SAMe-TTR 和 SAMe-TTG 评分验证，并评估与 TTR 相关的因素，以预测口服抗凝控制质量。
本前瞻性、多中心研究共纳入 379 例接受华法林治疗并随访 3 个月的 NVAF 患者。采用 TTR 评估口服抗凝控制质量。TTR 进行二分类 Logistic 回归分析，使用分类的截断值为控制不足（TTR<65.0%）。
379 例 NVAF 患者的平均 TTR 为 58.35±26.33%，中位 SAMe-TTR 和 SAMe-TTG 评分为 3 和 2。SAMe-TTR 和 SAMe-TTG 评分对控制不足（TTR<65.0%）的区分性能较差（C 指数<0.60）。基因频率为 3.2%，为 89.3%。初始治疗后，基因的变化对 TTR 没有影响。条件 TTR<65.0%与年龄<60 岁、无基因型指导的华法林剂量起始以及合用托拉塞米有关。
年龄>60 岁的患者初始治疗时使用华法林剂量调整算法有助于更好地控制口服抗凝质量，而合用托拉塞米可能产生负面影响。这些发现为未来研究中国抗凝临床实践中口服抗凝质量控制提供了有用的信息。
