This clinical score is based on routine clinical parameters, which can be used to identify patients who may be able to attain good anticoagulation control (eg, TTR $ 65%) with a VKA and those who probably will not, where an NOAC may be preferred or where other interventions (eg, more frequent INR monitoring, patient education/counseling, etc) may need to be implemented to ensure good INR control. Many of the factors included in the SAMe- TT2R2 score have been associated with decreased adherence with NOACs and in the absence of trial data it is not clear if these patients would do substantially better on an NOAC or if they would do poorly anyway. The SAMe-TT2R2 score has been assessed in 15 exclusively AF cohorts,174-185 reporting its predictive ability to forecast good or poor anticoagulation control, with c-statistics ranging from However, these cohorts were predominantly elderly, Western (white) populations, and its predictive ability in non-Western populations has relatively limited data as only 3 studies have assessed with only 1 reporting c-statistics (c-statistic, 0.54; In the multi-ethnic non-white Singaporean population by Bernaitis et al,174 the SAMe- TT2R2 score was able to dichotomize the patients likely to do well on VKA, compared with those (score > 2) more likely to achieve poor TTR. 