Incomenoy Supatcha, Saokaew Surasak, Poonchuay Natnicha
Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand.
Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
Ann Pharmacother. 2024 Feb;58(2):126-139. doi: 10.1177/10600280231166643. Epub 2023 Apr 26.
The SAMe-TTR 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-TTR and clinical outcomes remains controversial.
The objective is to assess the association of SAMe-TTR score with clinical outcomes and poor TTR in patients on VKAs.
We searched using the term "SAMe-TTR." Original articles reporting clinical outcomes and SAMe-TTR 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.
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-TTR scores ≥2 and ≥3, respectively, compared with lower scores. The diagnostic accuracy parameters for poor TTR were too heterogeneous to conclude. SAMe-TTR ≥3 significantly correlated with all adverse events (OR = 1.43 [95% CI: 1.29-1.54; < 0.001]), composite thromboembolism (OR = 1.53 [95% CI: 1.19-1.97; = 0.001]), and composite bleeding (OR = 1.33 [95% CI: 1.12-1.59; = 0.001] regardless of the indication, while an SAMe-TTR ≥2 significantly correlated with mortality (OR = 1.32 [95% CI: 1.02-1.70; = 0.033]). We found no relationship between an SAMe-TTR ≥3 and mortality or between a score ≥2 and clinical outcomes.
Patients on VKAs with SAMe-TTR ≥3 experienced more adverse events, bleeding, and thromboembolism compared with patients who had an SAMe-TTR <3. However, the score had limited and inconclusive predictability for poor TTR in the study.
S-腺苷甲硫氨酸-甲状腺素结合球蛋白（SAMe-TTR）评分可识别出服用维生素K拮抗剂（VKA）的患者中更有可能出现治疗范围内时间（TTR）不佳的情况；然而，SAMe-TTR与临床结局之间的关联仍存在争议。
评估SAMe-TTR评分与服用VKA的患者的临床结局及TTR不佳之间的关联。
我们使用“SAMe-TTR”一词进行检索。纳入2021年10月之前报告临床结局和SAMe-TTR评分的原始文章。提取临床结局的比值比（OR）、TTR不佳（<60%-70%）的诊断准确性参数以及平均TTR。使用随机效应模型进行荟萃分析。
纳入10项研究（N = 22894）；4项研究显示，与较低评分相比，SAMe-TTR评分≥2和≥3时，TTR的合并变化分别为-3.61%（95%CI：-4.88%至-2.35%）和-3.98%（95%CI：-6.08%至-1.87%）。TTR不佳的诊断准确性参数过于异质，无法得出结论。SAMe-TTR≥3与所有不良事件（OR = 1.43 [95%CI：1.29-1.54；P < 0.001]）、复合血栓栓塞（OR = 1.53 [95%CI：1.19-1.97；P = 0.001]）和复合出血（OR = 1.33 [95%CI：1.12-1.59；P = 0.001]）显著相关，无论适应证如何，而SAMe-TTR≥2与死亡率显著相关（OR = 1.32 [95%CI：1.02-1.70；P = 0.033]）。我们发现SAMe-TTR≥3与死亡率之间以及评分≥2与临床结局之间均无关联。
与SAMe-TTR<3的患者相比，SAMe-TTR≥3的服用VKA的患者发生更多不良事件、出血和血栓栓塞。然而，在该研究中，该评分对TTR不佳的预测性有限且尚无定论。
