Dear Editor,

We read with interest a recent publication on “SAME-TT2R 2 score and vitamin K antagonist therapy” published in Internal and Emergency Medicine [1]. Over the past few months there have been several reports concerning the usefulness of SAME-TT2R 2 score in clinical practice. Poli et al. [1] note that “the SAME-TT2R2 score is able to identify the patients who are less likely to do well on VKA therapy”. Some recent publications also show the usefulness of the score in predicting bleeding [2]. However, the important point is the complexity of the score, and its performance seems to be very complicated in day-to-day clinical practice [3]. Without good education and sufficient training, scoring cannot be successfully done [3]. Some authors have also reported concerns about the predictive value of the score itself. For instance, Skov et al. [4] note that the score does not “predict time in the therapeutic range of the international normalized ratio in patients attending a high-quality anticoagulation clinic”. Thus, an adjustment of the score seems to be required [5], and an individualized approach in using SAME-TT2R 2 score is suggested [6]. More in-depth studies, as an international multi-center project, to find the proper score for clinical application are recommended.