SAMe-TT2R2 score

:

Practical-Haemostasis.com
A Practical Guide to Haemostasis

Assessing the Risk of Bleeding in Patients with non-valvular Atrial Fibrillation [AF]:
The SAMe-TT2R2 Score

Introduction

The SAMe-TT₂R₂ score was originally devised as a system for identifying individuals with Atrial Fibrillation in whom poor anticoagulation control was likely to be a problem. It was subsequently evaluated in patients with acute VTE to establish whether individuals with a SAMe-TT₂R₂ score that would predict poor anticoagulant control with a Vitamin K antagonist e.g. Warfarin would be more effectively treated with a DOAC.

See References for further information on the SAMe-TT2R2 Algorithm.

The SAMe-TT2R2 Algorithm is summarised below:

The SAMe-TT2R2 Algorithm:

Select Criteria:

S Sex [Female]
	1 Point
A Age <60 yrs
	1 Point
Me Medical History¹
	1 Point
T Treatment [interacting]
	1 Point
T Tobacco Use [within 2 yrs]
	2 Points
R Race [non-Caucasian]
	2 Points

¹More than two of the following:
Diabetes, Myocardial Infarction, Peripheral arterial disease, Congestive cardiac failure, Previous CVA, Pulmonary disease, Hepatic or Renal Disease

Score

[Max Score 8 points]

Interpretation
Total No. of Points	Interpretation
0-2	Suggests the patient would benefit from a Vitamin K antagonist
>2	Suggests an alternative approach e.g. a DOAC - may be more appropriate.

Navigation

Screening Tests

Introduction & Bleeding Questionnaires
Prothrombin Time [PT]
Activated Partial Thromboplastin Time [APTT]
Thrombin Time [TT]
Fibrinogen Assays
Summary

Factor & Inhibitor Assays

Factor Assays
Introduction
1-Stage PT-based Factor Assays
1-Stage APTT-based Factor Assays
1-Stage RVV-based Factor X Assay
2-Stage Factor VIII Assay
Chromogenic FVIII and FIX Assays
Factor XIII Assays
Monitoring Concentrates and non-factor Therapies
Inhibitor Assays
Introduction
Inhibitor Screening Tests
Bethesda Assay
Nijmegen modification
VWF Inhibitor Assays
Von Willebrand Factor [VWF] Assays
Introduction
Immunological Assays
FVIII Binding Assay
VWF Collagen Binding Assay
VWF Ristocetin Cofactor Assay
VWF Epitope-Specific Assays
RIPA Assay
VWF Multimer Analysis
VWF Propeptide [VWFpp] Assay
VWF Inhibitor Assays

Platelet Function Testing

Introduction
Light Transmission Aggregometry [LTA]
Impedance Platelet Aggregometry
PFA-100/200
VerifyNow Assay
Global Thrombosis Test
Platelet Nucleotide Assays
Flow Cytometry
Platelet Procoagulant Assays

Thrombophilia Testing

Thrombophilia Testing - Introduction
Antithrombin Assays
Protein C Assays
Protein S Assays
APCr Assays
Protein C Global Assay
Homocysteine
Antiphospholipid Assays
Introduction
Dilute Russell Viper Venom Time [dRVVT]
Kaolin Clotting Time [KCT]
Silica Clotting Time [SCT]
Taipan Venom Time
Taipan:Ecarin Ratio
Textarin:Ecarin Ratio
Dilute Thromboplastin Inhibition Test [DTI]
Anticardiolipin & Anti-β₂ GPI Assays

Fibrinolytic Assays

Introduction
D-Dimer Assays
FDP Assays
Euglobulin Clot Lysis Time [ECLT]
Alpha2-PI Assays
Plasminogen Assays
PAI-1 Assays
t-PA Assays
TAFI Assays
u-PA Assays
Venous Occlusion Test
Global Assays of Fibrinolysis
GFC Assay
CloFAL Assay
OHP Assay
CIP Assay

Genetic Tests

Introduction
Bayesian Risk Analysis
Pascal's Triangle
Linkage Analysis
Mutational Analysis
Hardy Weinberg Principle
Prothrombin F2 G20201A Mutation
Factor V Leiden Mutation

Miscellaneous Tests

Activated Clotting Time [ACT]
Anti-Xa Assays
ADAMTS13 Assays
HIT and HIT Assays
Ecarin Clotting Time [ECT]
Protamine Sulphate Neutralisation Test
Prothrombinase-induced Clotting Test
Reptilase Time
Stypven Time
ISI and INR
Bleeding Time [BT]
Heparin Cofactor II [HCII] Assays
Prothrombin F1+2 Assays

Global Tests of Haemostasis

Introduction to Global Assays
ETP Assays
TEG and ROTEM Analyses
Global Thrombosis Test
ReoRox G2 Assay
Global Assays of Fibrinolysis
GFC Assay
CloFAL Assay
OHP Assay
CIP Assay

Quality Assurance

An introduction to Quality Assurance in Haemostasis
Pre-Analytical Variables

Risk Assessment Algorithms

Risk Assessment Algorithms: Introduction
Atrial Fibrillation and Ischaemic Stroke
Atrial Fibrillation and the Risk of Bleeding
Anti-Phospholipid Syndrome [APS]
Bleeding Assessment
DIC Assessment
Heparin-induced Thrombocytopaenia [HIT]
Post-Thrombotic Syndrome
Thrombotic Microangiopathies [TMAs]
Upper Extremity Thromboses
VTED Risk In Hospitalised Patients
VTED - Diagnosis
VTED - Assessing Bleeding Risk
VTED - Risk of Recurrence
VTED and Cancer

Useful Information

Paediatric Reference Ranges
Haemostatic Drugs
DOACs and Laboratory Tests
Snake Venoms in Haemostasis
Vitamin K & Haemostasis

Home Page

Data Interpretation App

EMBOLUS - THE APP

Miscellaneous

CONTACT US
SITE MAP
PRIVACY POLICY

Comments

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

The user of Practical-Haemostasis.com, assumes sole responsibility for any decisions made or actions taken based on the information contained herein.

LINKS & References

1. Apostolakis S, Sullivan RM, et al. Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT(2)R(2) score. Chest. 2013; 144: 1555-63.

2. van Miert JHA, Bos S, et al. Clinical usefulness of the SAMe-TT2R2 score: A systematic review and simulation meta-analysis. PloS one. 2018; 13: e0194208.

3. Borre ED, Goode A, et al. Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review. Thromb Haemost. 2018; 118: 2171-87.

5. Zulkifly H, Lip GYH, et al. Bleeding Risk Scores in Atrial Fibrillation and Venous Thromboembolism. The American Journal of Cardiology. 2017; 120: 1139-45.

6. Zulkifly H, Lip GYH, et al. Use of the SAMe-TT2R2 score to predict anticoagulation control in atrial fibrillation and venous thromboembolism patients receiving vitamin K antagonists: A review. Heart Rhythm : the official journal of the Heart Rhythm Society. 2018; 15: 615-23.

7. Click HERE to access the NICE guidelines on Atrial Fibrillation.

8. Click HERE to access the ACCP guideline on Anithrombotic Therapy for Atrial Fibrillation.