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Kürşat Bozkurt A, Tankut Akay H, Tanzer Çalkavur İ, Şırlak M, Onur Balkanay O, Uğuz E, Doğancı S, Polat A, Bayrak S, Bozok Ş, Barış Durukan A, Erdil N, Erer D, Şenay Ş, Utku Ünal E, Yavaş S. National guidelines on the management of venous thromboembolism: Joint guideline of the Turkish Society of Cardiovascular Surgery, National Society of Vascular and Endovascular Surgery, and Phlebology Society. Turk Gogus Kalp Dama 2021; 29:562-576. [PMID: 35096459 PMCID: PMC8762899 DOI: 10.5606/tgkdc.dergisi.2021.22121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
These evidence-based guidelines from the Turkish Society of Cardiovascular Surgery, National Society of Vascular and Endovascular Surgery, and Phlebology Society intend to support clinicians in best decisions regarding the treatment of venous thromboembolism (VTE). The Editor was selected by the three national societies and was tasked with the recruitment of the recognized panel. All financial support was solely derived from the sponsoring societies without the direct involvement of industry or other external stakeholders. The panel prioritized clinical questions and outcomes according to their importance for clinicians in terms of VTE. The panel agreed on 42 recommendations under 15 headings for the diagnosis, initial management, secondary prevention of VTE, and treatment of recurrent VTE events. Important recommendations included the use of ultrasonography, preference for home treatment over hospital treatment for uncomplicated VTE, preference for direct oral anticoagulants (DOACs) over vitamin K antagonists for primary treatment of cancer and non-cancer-related VTE, extended or indefinite anticoagulation with DOACs in selected high-risk patients. Early catheter-directed thrombectomy was recommended in only young symptomatic patients with a diagnosis of fresh iliofemoral deep vein thrombosis.
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EŞKUT N, TAMER P, YILMAZ KÜSBECİ Ö, ATAÇ C, İNCİ İ. Evaluation of Time in Therapeutic Range in Patients with Cerebrovascular Disease Receiving Treatment with Warfarin. Mustafa Kemal Üniversitesi Tıp Dergisi 2021. [DOI: 10.17944/mkutfd.937769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Emren ZY, Şenöz O, Erseçgin A, Emren SV. Evaluation of Bleeding Rate and Time in Therapeutic Range in Patients Using Warfarin Before and During the COVID-19 Pandemic-Warfarin Treatment in COVID-19. Clin Appl Thromb Hemost 2021; 27:10760296211021495. [PMID: 34142564 PMCID: PMC8216412 DOI: 10.1177/10760296211021495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal’s method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.
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Affiliation(s)
- Zeynep Yapan Emren
- Department of Cardiology, Çiğli Training and Education Hospital, Bakırçay University, Izmir, Turkey
| | - Oktay Şenöz
- Department of Cardiology, Çiğli Training and Education Hospital, Bakırçay University, Izmir, Turkey
| | - Ahmet Erseçgin
- Department of Cardiology, Çiğli Training and Education Hospital, Bakırçay University, Izmir, Turkey
| | - Sadık Volkan Emren
- Department of Cardiology, 226844Izmir Katip Celebi University School of Medicine, Izmir, Turkey
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Akgün AN, Karaçağlar E, Bal UA, Özin MB. Comparison of non-vitamin K antagonist oral anticoagulants and well-controlled warfarin in octogenarians with non-valvular atrial fibrillation: Real-world data from a single tertiary center. Anatol J Cardiol 2021; 25:462-467. [PMID: 34236320 DOI: 10.5152/anatoljcardiol.2021.25058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence increases with age. Nevertheless, data about the use of oral anticoagulants (OACs) among patients with ≥80 years remains limited. This study aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in octogenarians with non-valvular AF (NVAF). METHODS Medical records of 387 patients who were ≥80 years and diagnosed with NVAF in our hospital between January 2017 and December 2019 were evaluated retrospectively. Patients with NVAF were divided into 2 groups (NOACs and warfarin), and the incidence of stroke/systemic embolism and major bleeding were analyzed. RESULTS A total of 322 patients were included in the study. The median follow-up duration was 10.9 months for the NOACs group and 12.1 months for the warfarin group. The primary efficacy outcome was stroke/systemic embolism, and the primary safety outcome was major bleeding. A total of 220 patients were taking NOACs, and the most preferred NOACs were apixaban (53.6%), rivaroxaban (29.5%), dabigatran (13.2%), and edoxaban (3.6%) in this order. During a mean follow-up of 302.7 patient-years, the incidence of stroke or systemic embolic events was slightly higher among patients with warfarin but the difference was not statistically significant (p=0.862). The incidence rates of major bleeding events were similar between the treatment groups (p=0.824). CONCLUSION Our study revealed that the safety and efficacy outcomes are similar between the 2 treatment groups in octogenarians with NVAF.
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Affiliation(s)
- Arzu Neslihan Akgün
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
| | - Emir Karaçağlar
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
| | - Uğur Abbas Bal
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
| | - Mehmet Bülent Özin
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
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Abstract
Objectives: To evaluate the relationship between the nutritional status and sleep quality in patients diagnosed with atrial fibrillation as a cross-sectional correlational research. Methods: This cross-sectional correlational research was carried out with 108 patients between December 2017 and March 2018 who were admitted to the cardiology services of 2 different universities, diagnosed with atrial fibrillation and agreed to participate. Data collection was performed using internationally valid scales in order to evaluate the relationship between the nutritional status and sleep quality of patients diagnosed with atrial fibrillation. Results: Of the patients, 47.2% were men and 52.8% were women. Most of them (81.5%) were over the age of 60 years. The mean age was 68.99±14.02. Of the patients, 13% were malnourished, 57.4% were at risk of malnutrition, and 29.6% had a normal nutritional status. This study determined that their sleep quality worsened and their daytime sleepiness increased as their risk of malnutrition increased (p=0.000). Conclusion: The patients’ sleep quality worsened and their daytime sleepiness increased as the risk of malnutrition increased.
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Affiliation(s)
- Şeyma Şengül
- Department of Digestive System-Surgery, American Hospital Vehbi Koç Foundation, Istanbul, Turkey. E-mail.
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Başaran Ö, Beton O, Doğan V, Tekinalp M, Aykan AÇ, Kalaycıoğlu E, Bolat İ, Taşar O, Şafak Ö, Kalçık M, Yaman M, Altun İ, Soylu MÖ, Kırma C, Biteker M; RAMSES Study. ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in non-valvular atrial fibrillation (RAMSES study). Anatol J Cardiol 2016; 16:734-41. [PMID: 27723665 DOI: 10.14744/AnatolJCardiol.2016.6752] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials.gov identifier NCT02344901) in Turkey. Baseline demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables. Results: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6±10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA2DS2–VASc and HAS-BLED scores were 3.3±1.6 and 1.6±1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA). Conclusion: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients.
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Ben Halima A, Ouali S, Mourali MS, Chabrak S, Chettaoui R, Ben Halima M, Haggui A, Larbi N, Krichène S, Marrakchi S, Kacem S, Chrigui R, Abbes MF, Baccar H, Baraket N, Ben Halima N, Ben Khalfallah A, Ben Mbarek M, Ben Youssef S, Boughzala E, Boujnah MR, Drissa H, Gamra H, Gasmi A, Haouala H, Harrath Y, Issa I, Jeridi G, Kachboura S, Kammoun S, Kraiem S, Maatouk F, Milouchi S, Nasraoui W, Neji A, Sayahi K, Sdiri W, Smati W, Tlili S, Abid L, Abdesselem S, Zakhama L, Mahdhaoui A, Kammoun H, Ben Omrane S, Addad F. Design and Rationale of the National Tunisian Registry of Atrial Fibrillation: Protocol for a Prospective, Multicenter Trial. JMIR Res Protoc 2018; 7:e181. [PMID: 30322836 PMCID: PMC6231898 DOI: 10.2196/resprot.8523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited. Objective The aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial. Methods A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points. Results Results will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients. Conclusions This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region. Trial Registration ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX) Registered Report Identifier RR1-10.2196/8523
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Affiliation(s)
- Afef Ben Halima
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Sana Ouali
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Sonia Chabrak
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Rafik Chettaoui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Manel Ben Halima
- La Rabta Hospital, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Abdeddayem Haggui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Principal Military Hospital, Tunis, Tunisia
| | - Noureddine Larbi
- La Rabta Hospital, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Salma Krichène
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Sonia Marrakchi
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Abderrahman Mami Hospital, Ariana, Tunisia
| | - Slim Kacem
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Rim Chrigui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Habib Gamra
- Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ali Gasmi
- Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Ali Neji
- Ben Guerdane Hospital, Ben Guerdane, Tunisia
| | | | | | | | | | - Leila Abid
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Hédi Chaker Hospital, Sfax, Tunisia
| | - Salem Abdesselem
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Lilia Zakhama
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Hospital of the Internal Security Forces, La Marsa, Tunisia
| | - Abdallah Mahdhaoui
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Farhat Hached Hospital, Sousse, Tunisia
| | - Helmi Kammoun
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Skander Ben Omrane
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Faouzi Addad
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Abderrahman Mami Hospital, Ariana, Tunisia
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Kılıç S, Soner Kemal H, Yüce Eİ, Şimşek E, Yağmur B, Memişoğlu Akgül N, Soydaş Çınar C, Zoghi M, Gürgün C. Comparison of Warfarin use in terms of efficacy and safety in two different polyclinics. Anatol J Cardiol 2017; 18:328-33. [PMID: 29145216 DOI: 10.14744/AnatolJCardiol.2017.7886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: This study compared the efficacy and safety of warfarin in specialized international normalized ratio (INR) outpatient clinic (INR-C) and in general cardiology outpatient clinic (General-C). Methods: Herein, 381 consecutive patients with a regular follow-up at INR-C (n=233) or General-C (n=148) for at least 1 year were retrospectively included. While INR-C patients were followed by a single experienced trained nurse, General-C patients were followed by a different cardiologist who worked in a rotational principle every month. During controls, demographic characteristics, INR levels, bleeding events, ischemic stroke, and transient ischemic attacks in the last 1 year were recorded. Primary endpoint was defined as the evaluation of the combined major bleeding and ischemic event, and secondary endpoint was defined as the evaluation of them separately. Results: The mean age of the patients was 62±12.86 and 43.8% were male. Mean time in therapeutic range (TTR) level was statistically higher in INR-C than that in General-C (68.8%±15.88 and 51.6%±23.04, respectively; p<0.001). Primary outcomes were significantly higher in General-C than that in INR-C [13.5% (20) and 6.4% (15); respectively, p=0.020]. Overall, major bleeding was observed in 25 patients (6.5%) and (2.6%) ischemic event was observed in 10 patients. In General-C patients, both major bleeding (8.8% vs. 5.2%; p=0.163) and the ischemic event (4.7% vs. 1.3%; p=0.051) were more, and no statistically significant differences were detected between the two clinics. Conclusion: The findings of our study demonstrate that patients followed in INR-C had higher TTR levels and lower bleeding and ischemic events rates that those followed in General-C.
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Kılıç S, Çelik A, Çakmak HA, Afşin A, Tekkeşin Aİ, Açıksarı G, Memetoğlu ME, Özpamuk Karadeniz F, Şahan E, Alıcı MH, Dereli Y, Sinan ÜY, Zoghi M. The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study. Balkan Med J 2017; 34:349-355. [PMID: 28443575 PMCID: PMC5615968 DOI: 10.4274/balkanmedj.2016.1617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. Aims: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. Study Design: Cross-sectional study. Methods: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal’s algorithm. Awareness was evaluated based on the patients’ knowledge of the effect of warfarin and food-drug interactions with simple questions developed based on a literature review. Results: The Turkey-wide time in therapeutic range was reported as 49.5%±22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p<0.001). The highest rate was reported in the Marmara region (54.99%±20.91) and the lowest was in the South-eastern Anatolia region (41.95±24.15) (p<0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p<0.001). Conclusion: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey.
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Affiliation(s)
- Salih Kılıç
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Çelik
- Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
| | | | - Abdülmecit Afşin
- Department of Cardiology, İnönü University School of Medicine, Malatya, Turkey
| | - Ahmet İlker Tekkeşin
- Clinic of Cardiology, Siyami Ersek Training and Research Hospital, İstanbul, Turkey
| | - Gönül Açıksarı
- Clinic of Cardiology, İstinye State Hospital, İstanbul, Turkey
| | - Mehmet Erdem Memetoğlu
- Clinic of Cardiovascular Surgery, Siyami Ersek Training and Research Hospital, İstanbul, Turkey
| | | | - Ekrem Şahan
- Clinic of Cardiology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Yüksel Dereli
- Department of Cardiovascular Surgery, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University Institute of Cardiology, İstanbul, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
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Diken Aİ, Yalçınkaya A, Hanedan MO, Erol ME, Ercen Diken Ö. Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis. Phlebology 2017; 33:53-59. [DOI: 10.1177/0268355516688358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.
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Affiliation(s)
- Adem İ Diken
- Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey
| | - Adnan Yalçınkaya
- Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey
| | - Muhammet O Hanedan
- Ahi Evren Thorax, Heart and Vascular Education and Training Hospital, Cardiovascular Surgery, Trabzon, Turkey
| | - Mehmet E Erol
- Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey
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Çelik A, İzci S, Kobat MA, Ateş AH, Çakmak A, Çakıllı Y, Yılmaz MB, Zoghi M. The awareness, efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TR. Anatol J Cardiol 2015; 16:595-600. [PMID: 27004711 PMCID: PMC5368516 DOI: 10.5152/anatoljcardiol.2015.6474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: The awareness, time in therapeutic range (TTR), and safety of warfarin therapy were investigated in the adult Turkish population. Methods: This multicenter prospective study includes 4987 patients using warfarin and involved regular international normalized ratio (INR) monitoring between January 1, 2014 and December 31, 2014. TTR was calculated according to F.R. Roosendaal’s algorithm. Awareness was evaluated based on the patients’ knowledge of warfarin’s affect and food–drug interactions. Results: The mean TTR of patients was 49.52±22.93%. The patients with hypertension (55.3%), coronary artery disease (23.2%), congestive heart failure (24.5%), or smoking habit (20.8%) had significantly lower TTR levels than the others. Of the total number of patients, 42.6% had a mechanical valve, 38.4% had non-valvular atrial fibrillation (AF), and 19% had other indications for warfarin. Patients with other indications had lower TTR levels than those with mechanical valve and non-valvular AF (p=0.018). Warfarin awareness decreased in higher age groups. The knowledge of warfarin’s food–drug interactions was 55%. People with higher warfarin awareness had higher TTR levels. Patients with ≤8 INR monitoring/year had lower TTR levels (46.4±25.3 vs. 51.1±21.3, respectively, p<0.001) and lower awareness (44.6% vs. 60.6%, p<0.001) than patients with ≥8 INR monitoring/year. In this study, 20.1% of the patients had a bleeding event (major bleeding 15.8%, minor bleeding 84.2%) within a year. Conclusion: Both the mean TTR ratios and awareness of the Turkish population on warfarin therapy were found to be low. It was thought that low TTR levels of the Turkish population may be caused by the low awareness of warfarin, warfarin’s food–drug interactions, and high rates of concomitant diseases. (Anatol J Cardiol 2016; 16: 595-600)
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Affiliation(s)
- Ahmet Çelik
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin-Turkey.
| | - Servet İzci
- Department of Cardiology, Koşuyolu Education and Research Hospital, İstanbul-Turkey
| | - Mehmet Ali Kobat
- Department of Cardiology, Faculty of Medicine, Fırat University, Elazığ-Turkey
| | - Ahmet Hakan Ateş
- Department of Cardiology, Samsun Education and Research Hospital, Samsun-Turkey
| | - Abdülkadir Çakmak
- Department of Cardiology, Faculty of Medicine, Amasya University, Amasya-Turkey
| | - Yasin Çakıllı
- Department of Cardiology, Siyami Ersek Education and Research Hospital, İstanbul-Turkey
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas-Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir-Turkey
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12
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Akıl MA, Akıl E, Bilik MZ, Oylumlu M, Acet H, Yıldız A, Akyüz A, Ertaş F, Toprak N. The relationship between atrial electromechanical delay and left atrial mechanical function in stroke patients. Anatol J Cardiol 2014; 15:565-70. [PMID: 25537998 PMCID: PMC5337037 DOI: 10.5152/akd.2014.5558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between atrial electromechanical delay (EMD) measured with tissue Doppler imaging (TDI) and left atrial (LA) mechanical functions in patients with ischemic stroke and compare them with healthy controls. METHODS Thirty patients with ischemic stroke were enrolled into this cross-sectional, observational study. The control group consisted of 35 age- and gender-matched apparently healthy individuals patients. Acute cerebral infarcts of probable embolic origin were diagnosed via imaging and were confirmed by a neurologist. Echocardiographically, time intervals from the beginning of P wave to beginning of A wave from the lateral and septal mitral and right ventricular tricuspid annuli in TDI were recorded. The differences between these intervals gave the mechanical delays (inter- and intra-atrial). Left atrial (LA) volumes were measured using the biplane area-length method, and LA mechanical function parameters were calculated. Statistical analysis was performed using student's t-test, chi-squared test, and Pearson's test. RESULTS The laboratory and clinical characteristics were similar in the two groups. Increased left atrial EMD (21.36±10.38 ms versus 11.74±6.06 ms, p<0.001), right atrial EMD (13.66±8.62 ms versus 9.66±6.81 ms, p=0.040), and interatrial EMD (35.03±9.95 ms versus 21.40±8.47 ms, p<0.001) were observed in stroke patients as compared to controls. Active LA emptying volume and fraction and passive LA emptying volumes and fraction were similar between controls and stroke patients. Total LA emptying volumes were significantly increased in stroke patients as compared to healthy controls (33.19±11.99 mL/m2 versus 27.48±7.08 mL/m2, p=0.021). CONCLUSION According to the results of our study, interatrial electromechanical delay may be a new predictor for ischemic stroke.
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Affiliation(s)
- Mehmet Ata Akıl
- Department of Cardiology, Faculty of Medicine, Dicle University; Diyarbakır-Turkey.
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13
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Aslan O, Yaylali YT, Yildirim S, Yurtdas M, Senol H, Ugur-Yildiz M, Ozdemir M. Dabigatran Versus Warfarin in Atrial Fibrillation. Clin Appl Thromb Hemost 2014; 22:147-52. [DOI: 10.1177/1076029614546327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Safety issues have been raised about dabigatran. We aimed to investigate the occurrence of safety outcomes in patients who had atrial fibrillation and a risk of stroke. We analyzed 439 patients prescribed dabigatran (n = 220) or warfarin (n = 219). Ischemic stroke occurred in 15 (6.8%) patients in the warfarin group versus 5 (5.2%) patients in the 110-mg group versus 1 (0.8%) patient in the 150-mg dabigatran group ( P = .015). Intracranial hemorrhage occurred in 6 (2.7%) patients in the warfarin group versus 3 (2.4%) patients in the 150-mg dabigatran group ( P = .104). Death from any cause occurred in 10 (4.6%) patients in the warfarin group versus 1 (1.0%) patient in the 110-mg dabigatran group ( P = .005). Dabigatran was associated with less ischemic stroke and death from any cause than warfarin. Dabigatran may be a better option for stroke prophylaxis, where recommended monitoring with warfarin is suboptimal.
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Affiliation(s)
- Onur Aslan
- Division of Cardiology, Ağrı State Hospital, Ağrı, Turkey
| | - Y. T. Yaylali
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - S. Yildirim
- Division of Emergency Medicine, Ağrı State Hospital, Ağrı, Turkey
| | - M. Yurtdas
- Department of Cardiology, Van Region Training and Research Hospital, Van, Turkey
| | - H. Senol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - M. Ugur-Yildiz
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - M. Ozdemir
- Department of Cardiology, Van Region Training and Research Hospital, Van, Turkey
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14
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Karavelioğlu Y, Karapınar H, Yüksel M, Memiç K, Sarak T, Kurt R, Yilmaz A. Neutrophil to lymphocyte ratio is predictor of atrial fibrillation recurrence after cardioversion with amiodarone. Clin Appl Thromb Hemost 2014; 21:5-9. [PMID: 24431383 DOI: 10.1177/1076029613518368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In this study, our aim is to examine the role of the neutrophil to lymphocyte ratio (NLR) in the predictions of recurrence under long-term follow-up in patients whose sinus rhythms (SRs) were restored with amiodarone in acute atrial fibrillation (AF). METHODS Retrospectively, patients with acute AF, which successfully converted to the SR with amiodarone treatment, were recruited into the study. Patients experiencing the first AF attack were enrolled to the study and followed up for 5 years (median 23 months, 25-75 percentiles 12-24 months). Neutrophil to lymphocyte ratio was computed as absolute neutrophil count divided by lymphocyte count. RESULTS A total of 218 patients were recruited into the study and followed up for 21.6 ± 13.9 months; 87 (40%) patients had ≥1 recurrent AF attack within this period. The follow-up of 131 (60%) patients resulted in persisted SR without any other AF attack. Groups were similar in terms of age and gender. Left atrium (LA) diameter and NLR were increased, and platelet count and lymphocyte count were decreased in patients with AF recurrence in univariate analysis (P < .05 for all). Only LA diameter (for per mm, 1.077 [1.021-1.136], P = .006) and NLR (1.584 [1.197-2.095], P = .001) were independent predictors of AF recurrence in the multivariate analysis. CONCLUSION Increased NLR is a marker of increased inflammation and may serve as simple, cheap, and readily available predictors of recurrence in the long-term follow-up of patients admitted with acute AF and successfully converted to SR with amiodarone.
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Affiliation(s)
- Yusuf Karavelioğlu
- Department of Cardiology, Çorum Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Hekim Karapınar
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Murat Yüksel
- Department of Cardiology, Dicle University Medical School, Diyarbakır, Turkey
| | - Kadriye Memiç
- Department of Cardiology, Çorum Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Taner Sarak
- Department of Cardiology, Çorum Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Recep Kurt
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Ahmet Yilmaz
- Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
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15
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Acet H, Ertaş F, Akıl MA, Oylumlu M, Polat N, Yıldız A, Bilik MZ, Yüksel M, Kaya Z, Ulgen MS. New inflammatory predictors for non-valvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Int J Cardiovasc Imaging 2013; 30:81-9. [PMID: 24162180 DOI: 10.1007/s10554-013-0317-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Abstract
The objective of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and neutrophil to lymphocyte ratio (NLR) with different types of non-valvular atrial fibrillation (AF) in a clinical setting. A total of 197 consecutive patients were enrolled in the study. Seventy-one patients had paroxysmal non-valvular AF, 63 patients had persistent/permanent non-valvular AF, and 63 patients had sinus rhythm (control group). EFT was measured with echocardiography, while NLR was measured by dividing neutrophil count by lymphocyte count. EFT was significantly higher in patients with paroxysmal non-valvular AF compared with those in the sinus rhythm group (6.6 ± 0.7 vs. 5.0 ± 0.9 mm, p < 0.001). Persistent/permanent non-valvular AF patients had a significantly larger EFT compared with those with paroxysmal AF (8.3 ± 1.1 vs. 6.6 ± 0.7 mm, p < 0.001). EFT had a significant relationship with paroxysmal non-valvular AF (odds ratio 4.672, 95 % CI 2.329-9.371, p < 0.001) and persistent/permanent non-valvular AF (OR 24.276, 95% CI 9.285-63.474, p < 0.001). NLR was significantly higher in those with paroxysmal non-valvular AF compared with those in the sinus rhythm group (2.5 ± 0.6 vs. 1.8 ± 0.4, p < 0.001). Persistent/permanent non-valvular AF patients had a significantly larger NLR when compared with paroxysmal non-valvular AF patients (3.4 ± 0.6, vs. 2.5 ± 0.6, p < 0.001). NLR (>2.1) had a significant relationship with non-valvular AF (OR 11.313, 95% CI 3.025-42.306, b 2.426, p < 0.001). EFT and NLR are highly associated with types of non-valvular AF independent of traditional risk factors. EFT measured by echocardiography and NLR appears to be related to the duration and severity of AF.
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Affiliation(s)
- Halit Acet
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
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16
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Kaya H, Ertaş F, Köroğlu B, Vatan B, Çağlıyan ÇE, Gedik S, Yeter E, Aydin M, Akil MA, Soydinç MS, Ozhan H, Ülgen MS. Predictors of Anticoagulant Treatment in Patients With Nonvalvular Atrial Fibrillation. Clin Appl Thromb Hemost 2013; 21:144-8. [DOI: 10.1177/1076029613491459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.
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Affiliation(s)
- Hasan Kaya
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Faruk Ertaş
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Bayram Köroğlu
- Department of Cardiology, Siyami Ersek Education and Research Hospital, Istanbul, Turkey
| | - Bülent Vatan
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Selçuk Gedik
- Department of Cardiology, Numune Education and Research Hospital, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Yildirim Beyazit University, Diskapi Education and Research Hospital, Ankara, Turkey
| | - Mesut Aydin
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet Ata Akil
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | | | - Hakan Ozhan
- Department of Cardiology, Duzce University Faculty of Medicine, Duzce, Turkey
| | - Mehmet Sıddık Ülgen
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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