Browsing by Author "Bal, Uğur Abbas"

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    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
    (2021) Akgun, Arzu Neslihan; Karacaglar, Emir; Bal, Uğur Abbas; Ozin, Mehmet Bulent; 34236320
    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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    Plazma asimetrik dimetilarjinin düzeyi stent restenozu için bir belirteç olabilir mi?
    (Başkent Üniversitesi Tıp Fakültesi, 2008) Bal, Uğur Abbas; Yıldırır, Aylin
    Günümüzde stentler, koroner arter hastalığında bir tedavi seçeneği olarak sıklıkla kullanılmaktadır. Stentler koroner arter hastaları için bir umut olmuş fakat kullanımları arttıkça başta restenoz olmak üzere bazı problemler ile karşılaşılmıştır. Düz kas hücresi ve matriksten oluşan neointima hiperplazisi stent içi restenozun başlıca nedenidir. Sağlam endotelden salınan nitrik oksit (NO) düz kas hücre proliferasyonunu önleyerek neointima hiperplazisini azaltır. Asimetrik dimetilarjinin (ADMA), endotelyal NO oluşumunda bir düzenleyicidir. Nitrik oksit sentetaz (NOS)’ ın yarışmacı inhibitörüdür. Bu çalışmanın amacı plazma ADMA düzeyinin stent restenozunda bir belirteç olup olamayacağını değerlendirmektir. Çalışmaya daha önce koroner stent uygulanmış ve herhangi bir nedenle koroner anjiyografi yapılan 91 hasta alındı. Kronik böbrek ve karaciğer yetmezliği, son 1 yıl içinde gelişen serebrovasküler olay, ciddi periferik arter hastalığı, kontrolsüz hipertansiyon (HT)’ u, klinik hipertiroidisi, erektil disfonksiyonu ve pulmoner hipertansiyonu olan hastalar ile kan glukozu kontrol altında olmayan diabet hastaları çalışma dışı bırakıldı. Tüm hastalarda ADMA plazmadan yüksek performanslı sıvı kromotografisi (HPLC) yöntemiyle çalışıldı. Çalışmaya alınan hastaların yaş ortalaması 58.9 ± 8.7 yıl olup, 72 (% 79.1)’ i erkekti. Çalışmaya alınan 91 hastanın toplam 144 stenti anjiyografik olarak değerlendirildi ve 46 (% 31.9)’ ında restenoz saptandı. Hasta bazında ise 35 (% 38.5) hastada restenoz tespit edildi. Restenoz gelişen ve gelişmeyen hastalar klinik ve laboratuvar özellikleri bakımından karşılaştırıldığında akut koroner sendrom (AKS) kliniği nedenli stent takılma öyküsü restenoz gelişen grupta anlamlı olarak daha yüksekti (p = 0.029). Laboratuvar parametrelerinden plazma ADMA düzeyi (p = 0.001), C-reaktif protein düzeyi (p = 0.01) ve beyaz küre sayısı (p = 0.044) restenoz gelişen grupta anlamlı derecelerde yüksek, sol ventrikül ejeksiyon fraksiyonu ise anlamlı derecede düşük idi (p = 0.023). Çoklu lineer regresyon analizinde plazma ADMA düzeyi (β = 0.281; p = 0.012) ve stent öncesi hastanın kliniği (β = 0.233; p = 0.037) restenozun bağımsız belirleyicileri olarak tespit edildi. Stent özellikleri ve uygulanma yöntemleri değerlendirildiğinde ise stent boyu (β = 0.238; p = 0.015) ve stent çapı (β = – 0.302; p = 0.001) restenoz gelişimi için bağımsız risk faktörleri olarak bulundu. Sonuç olarak, plazma ADMA düzeyi stent restenozu gelişiminin bağımsız bir belirleyicisidir. Nowadays stents are widely used for the treatment of coronary artery disease. During the wide spread usage of coronary stenting, stent restenosis was found to be the major problem related with this intervention. Neointimal hyperplasia composed of vascular smooth muscle cells and the matrix is the mainstay of stent restenosis. Nitric oxide secreted by intact endothelium inhibits vascular smooth muscle cell proliferation and prevents neointimal hyperplasia. Asymmetric dimethylarginine (ADMA) is a potent competitive inhibitor of nitric oxide synthase (NOS). The aim of this study was to examine whether plasma ADMA level is a predictor of stent restenosis or not. We recruited 91 patients with a history of coronary stenting who underwent coronary angiography due to various reasons. Subjects were eligible if they had no history of chronic kidney or liver disease, no history of cerebrovascular accident in the past year and were free of uncontrolled hypertension, clinical hyperthyroidism, erectile dysfunction, pulmonary hypertension and uncontrolled diabetes mellitus. Asymmetric dimethylarginine concentrations were measured by high performance liquid chromatography (HPLC). The mean age of the patients was 58.9 ± 8.7 years and 72 (79.1 %) of them were male. We assessed 144 stents of 91 patients with coronary angiography. Angiographic restenosis was found in 35 patients (38.5 %) and 46 of 144 stents (31.9 %). When clinical characteristics and laboratory findings considered, stenting history due to acute coronary syndrome (p = 0.029), plasma ADMA concentrations (p = 0.001), C-reactive protein concentrations (p = 0.01) and white blood cell count (p = 0.044) were higher and left ventricular ejection fraction (p = 0.023) lower in patients with restenosis. Plasma ADMA concentration (β = 0.281; p = 0.012) and clinical setting before stenting (β = 0.233; p = 0.037) were found to be the independent predictors of restenosis in multiple linear regression analysis. When we consider the properties of stent and the implantation procedure, we found the stent diameter (β = – 0.302; p = 0.001) and length (β = 0.238; p = 0.015) as the independent predictors of restenosis. In conclusion, plasma ADMA level is found to be an independent predictor of restenosis.