학술논문
Atrial Fibrillation Management in Acute Stroke Patients in Turkiye: Real-life Data from the NoroTek Study/Turkiye'de Inme Hastalarinda Atrial Fibrilasyonun Yonetimi: NoroTek Calismasi Gercek? Hayat Verileri
Original Article / Ozgun Arastirma
Original Article / Ozgun Arastirma
Document Type
Report
Author
Topcuolu, Mehmet Akif; Arsava, Ethem Murat; Ozdemir, Atilla Ozcan; Aykac, Ozlem; Cetiner, Mustafa; Gencer, Elif Sarionder; Gunes, Aygul; Krespi, Yakup; Yaka, Erdem; Ocek, Levent; Tannverdi, Zeynep; Tekan, Ulgen Yalaz; Ozkul, Ayca; Ozkan, Esra; Sirin, Hadiye; Guler, Ayse; Kursun, Oguzhan; Kunt, Refik; Cenikli, Utku; Acar, Bilgehan; Kablan, Yuksel; Yilmaz, Ayse; Isikay, Canan Togay; Aslanbaba, Eda; Sorgun, Mine; Bektas, Hesna; Cabalar, Murat; Yayla, Vildan; Erdogan, Haci Ali; Gokce, Mustafa; Bavli, Songul; Ongun, Nedim; Keskin, Ahmet Onur; Akdoan, Ozlem; Emre, Ufuk; Yildiz, Ozlem Kayim; Bolayir, Asli; Akpinar, Cetin Kursad; Karadeli, Hasan Huseyin; zel, Tugba; Unal, Ali; Dora, Babur; Arer, Zlfikar; Eren, Alper; Milanoglu, Aysel; Nazliel, Bijen; Caglayan, Hale Batur; Guven, Bulent; Erdogan, Mucahid; Acar, Zeynep OzdemirBakar, Mustafa; Giray, Semih; Senadim, Songul; Asil, Talip; Demir, Turgay; Unsal, Yaprak Ozum; Eskut, Neslihan; Aslan, Yildiz; Bas, Demet Funda; Sener, Ufuk; Degirmenci, Bahar; Aluclu, Ufuk; Batan, Birgul; Acar, Zeynep; Niflioglu, Buket; Yazici, Duran; Aytac, Emrah; Ince, Fatma Birsen; Ay, Halil; Onder, Halil; Kozak, Hasan Huseyin; Ilgezdi, Irem; Bilgic, Adnan Burak; Akyol, Senol; Gungor, I. Levent; Atmaca, Murat Mert; Sen, Mustafa; Yevgi, Recep; Akkas, Sinem Yazici; Yolda, Tahir; Atasoy, H. Tugrul; Cinar, Bilge Piri; Yilmaz, Arda; Genc, Hamit; Kisabay, Aysin; Ilik, Faik; Demirbas, Hayri; Midi, Ipek; Sirinocak, Pinar Bekdik; Duman, Taskin; Demir, Tulin; Can, Ufuk; Yurekli, Vedat Ali; Bozdogan, Zehra; Alioglu, Zekeriya; Kaya, Dilaver; Afsar, Nazire; Gurkas, Erdem; Toplutas, Eren; Degirmenci, Eylem; Buyukserbetci, Gulseren; Aydn, Isa; Epceliden, M. Tuncay; Turgut, Nilda; Kale, Nilufer; Coban, Eda; Yesilot, Nilufer; Ekizoglu, Esme; Kizek, Ozgu; Bilgili, Ozlem; Baydemir, Recep; Akcakoyunlu, Merve; Yilmaz, Zahide; Ozturk, Serefnur
Source
Turkish Journal of Neurology. September 2023, Vol. 29 Issue 3, p183, 7 p.
Subject
Language
English
ISSN
1301-062X
Abstract
Introduction Atrial fibrillation (AF) is among the most common directly preventable causes of ischemic stroke (1). In Turkiye, there is no large-scale neurology-based data on medical practices to prevent stroke [...]
Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis. Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio [greater than or equal to]2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug. Conclusion: NoroTek (TR) revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known A F. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by A F. Keywords: Acute stroke, transient ischemic attack, anticoagulant, relapse, therapeutic dose, Holter monitoring Amac: Atrial fibrilasyon (AF) iskemik inmenin dogrudan onlenebilir en sik nedendir. Ulkemizde AF nedenli inme spektrumuna dair noroloji kaynakli genis olcekte bir veri bulunmamaktadir. NoroTek-Turkiye (TR) kapsaminda akut inme algoritmalarinin olusturulmasina katki yapmasi beklenen AF tespit edilen akut inme hastalarina dair hastane verisi toplanmistir. Gerec ve Yontem: 10 Mayis 2018 Dunya Inme Farkindalik Gunu'nde 30 saglik bolgesine yer alan 87 noroloji biriminde yatmakta olan 1.790 hasta prospektif olarak degerlendirilmistir. Calismada yer alan toplam 929 hasta [859 akut iskemik inme, 70 gecici iskemik atak (GIA)] bu analize dahil edilmistir. Bulgular: Iskemik inme/GIA sebebiyle ile interne edilmis hastalarda AF orani %29,8 olup bunlarin %65'i bilinmekte olan, %5'i paroksismal ve %30'u yeni tanidir. AF tanisi ile gelen hastalarda "etkin" tedavi [internasyonel normalizasyon orani [greater than or equal to]2,0 varfarin veya rehber dozunda non-vitamin K antagonist oral antikoagulan (NOAK)] alanlarin orani %25,3 olup, %42,5 olguda ya hic ilac kullanilmamakta ya da sadece antiplatelet kullanilmaktaydi. Dusuk doz kullanim orani 42 NOAK alirken inme gecirmis olguda %50 idi. Taburcu edilirken antikoagulan %94,6 (dusuk molekul agirlikli veya non-fraksiyone heparin %28,1; varfarin %32,5 ve NOAK %31) hastaya recete edilmisti. NOAK ile taburcu edilen olgularin %22'sinde doz dusuk kategoride olup geliste NOAK almakta olan olgularin yarisi ayni ilacla taburcu edilmistir. Sonuc: NoroTek (TR) ulkemizde AF'nin akut inmedeki sikligi yani sira sekonder proflaksi perspektifinde yonetiminin gelistirilebilecek yonlerini ortaya koydu. Turkiye'de hastanede yatan akut inme olgularinin yaklasik ucte birinde AF saptanmistir. AF'si bilinen akut inme olgularinin dortte ucunde etkin antikoagulan tedavi kullanilmamaktaydi. AF'de inme sekonder proflaksisi kapsaminda heparin, varfarin ve NOAK planlamasi benzer siklikta (ucte bir) olup recete edilen NOAK dozu dortte bir olguda subterapotiktir. AF'ye bagli inmenin onlenebilmesi non-medikal ve medikal egitim gerekli gorunmektedir. Anahtar Kelimeler: Akut inme, gecici iskemik atak, antikoagulan, nuks, terapotik doz, Holter monitorizasyon
Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis. Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio [greater than or equal to]2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug. Conclusion: NoroTek (TR) revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known A F. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by A F. Keywords: Acute stroke, transient ischemic attack, anticoagulant, relapse, therapeutic dose, Holter monitoring Amac: Atrial fibrilasyon (AF) iskemik inmenin dogrudan onlenebilir en sik nedendir. Ulkemizde AF nedenli inme spektrumuna dair noroloji kaynakli genis olcekte bir veri bulunmamaktadir. NoroTek-Turkiye (TR) kapsaminda akut inme algoritmalarinin olusturulmasina katki yapmasi beklenen AF tespit edilen akut inme hastalarina dair hastane verisi toplanmistir. Gerec ve Yontem: 10 Mayis 2018 Dunya Inme Farkindalik Gunu'nde 30 saglik bolgesine yer alan 87 noroloji biriminde yatmakta olan 1.790 hasta prospektif olarak degerlendirilmistir. Calismada yer alan toplam 929 hasta [859 akut iskemik inme, 70 gecici iskemik atak (GIA)] bu analize dahil edilmistir. Bulgular: Iskemik inme/GIA sebebiyle ile interne edilmis hastalarda AF orani %29,8 olup bunlarin %65'i bilinmekte olan, %5'i paroksismal ve %30'u yeni tanidir. AF tanisi ile gelen hastalarda "etkin" tedavi [internasyonel normalizasyon orani [greater than or equal to]2,0 varfarin veya rehber dozunda non-vitamin K antagonist oral antikoagulan (NOAK)] alanlarin orani %25,3 olup, %42,5 olguda ya hic ilac kullanilmamakta ya da sadece antiplatelet kullanilmaktaydi. Dusuk doz kullanim orani 42 NOAK alirken inme gecirmis olguda %50 idi. Taburcu edilirken antikoagulan %94,6 (dusuk molekul agirlikli veya non-fraksiyone heparin %28,1; varfarin %32,5 ve NOAK %31) hastaya recete edilmisti. NOAK ile taburcu edilen olgularin %22'sinde doz dusuk kategoride olup geliste NOAK almakta olan olgularin yarisi ayni ilacla taburcu edilmistir. Sonuc: NoroTek (TR) ulkemizde AF'nin akut inmedeki sikligi yani sira sekonder proflaksi perspektifinde yonetiminin gelistirilebilecek yonlerini ortaya koydu. Turkiye'de hastanede yatan akut inme olgularinin yaklasik ucte birinde AF saptanmistir. AF'si bilinen akut inme olgularinin dortte ucunde etkin antikoagulan tedavi kullanilmamaktaydi. AF'de inme sekonder proflaksisi kapsaminda heparin, varfarin ve NOAK planlamasi benzer siklikta (ucte bir) olup recete edilen NOAK dozu dortte bir olguda subterapotiktir. AF'ye bagli inmenin onlenebilmesi non-medikal ve medikal egitim gerekli gorunmektedir. Anahtar Kelimeler: Akut inme, gecici iskemik atak, antikoagulan, nuks, terapotik doz, Holter monitorizasyon