PubMed Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10763
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Item Real-Life Data of Major and Minor Bleeding Events with Direct Oral Anticoagulants in the One-Year Follow-Up Period: The NOAC-TURK Study(2021) Gedikli, Omer; Altay, Servet; Unlu, Serkan; Cakmak, Huseyin Altug; Askin, Lutfu; Yanik, Ahmet; Besli, Feyzullah; Sinan, Umit Yasar; Canpolat, Ugur; Sahin, Mahmut; Pehlivanoglu, Seckin; 33690135; ABC-9264-2021Objective: This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice. Methods: This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged >= 18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC. Results: A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6 +/- 10.2 years, CHA2DS2-VASc score was 3.6 +/- 1.4, and HAS-BLED score was 2 +/- 1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p<0.001). Patients on rivaroxaban 15 mg od also had a higher prevalence of chronic renal failure, 46 (16.7%) patients. A total of 205 (11.4%) bleeding events were observed; among these, 34 (1.9%) patients had major bleeding and 171 (9.4%) patients had minor bleeding. The major and minor bleeding events were 2/273 (0.7%) and 30/273 (10.9%) in patients receiving dabigatran 150 mg bid, 13/409 (3%) and 44/409 (10.7%) in patients receiving dabigatran 110 mg bid, 4/385 (1%) and 42/385 (10.9%) in patients receiving rivaroxaban 20 mg od, 8/276 (2.9%) and 27/276 (9.7%) in patients receiving rivaroxaban 15 mg od, 3/308 (0.9%) and 14/308 (4.5%) in patients receiving apixaban 5 mg bid, 4/156 (2.5%) and 14/156 (9%) in patients receiving apixaban 2.5 mg bid, respectively. The total bleeding events were 17 (5.6%) in patients receiving apixaban 5 mg, less than those receiving other DOACs. On multivariate analyses, rivaroxaban 20 mg od (p=0.002), ATRIA and HAS-BLED scores, and peripheral artery disease were independent indicators of bleeding. The most frequent location of major bleeding was the gastrointestinal system (GIS) [17 (0.9%) patients], and the most frequent location of minor bleeding was the gingiva [45 (2.5%) patients]. Conclusion: This study showed that similar results as the previous real-life study; however, we had some different results, such as the GIS tract bleeding was more frequent in patients receiving dabigatran 110 mg bid. The major and intracranial bleeding events were similar for different DOACs; and among DOACs, only rivaroxaban 20 mg od was associated with a high risk of bleeding.Item Effect of acute kidney injury on long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention in a high-volume tertiary center(2020) Hayiroglu, Mert Ilker; Bozbeyoglu, Emrah; Yildirimturk, Ozlem; Tekkesin, Ahmet Ilker; Pehlivanoglu, Seckin; 31974325Objective: Acute kidney injury (AKI) is a reflection of both renal and cardiac reserve in patients with ST-segment elevation myocardial infarction (STEMI), but there is a lack of evidence related to the effect of AKI on long-term mortality in patients with STEMI. This study was an investigation of the prognostic value of AKI for long-term mortality in patients with STEMI complicated by cardiogenic shock (CS) and primary percutaneous coronary intervention (PPCI). Methods: This retrospective analysis evaluated the long-term prognostic impact of AKI on 492 patients with STEMI complicated by CS who were treated with PPCI. AKI was defined as >= 0.3mg/dL increase in serum creatinine within 48 hours or a >= 50% increase in serum creatinine in 7 days, or a reduction in urine output (documented oliguria of less than 0.5mL/kg per hour >6 hours. Patients were grouped according to the incidence of AKI and long-term mortality was compared. Cox regression analysis was used to determine independent prognostic factors of long-term mortality. Results: In Cox regression analysis, the age- and sex- adjusted hazard ratios (HRs) were higher for all-cause mortality in patients with AKI. [HR: 4.556; 95% confidence interval: (CI) 2.370-8.759]. After adjustment for confounding variables, the relative risk was greater for patients with AKI in comparison with patients without AKI (HR: 2.207; 95% CI: 1.150-4.739). Age (HR: 1.060, 95% CI: 1.027-1.094; p<0.001), left ventricular ejection fraction (HR: 0.952, 95% CI: 0.916-0.989; p=0.012), blood urea nitrogen level (HR: 1.019, 95% CI: 1.005-1.034; p=0.010), and AKI (HR: 2.244, 95% CI: 1.077-4.676; p=0.031) were found to be independent factors to determine long-term mortality. Conclusion: The results of this study demonstrated that AKI was an independent prognostic factor for long-term mortality among patients with STEMI complicated by CS and treated with PPCI.Item Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study(2020) Kocabas, Umut; Sariturk, Cagla; Altay, Hakan; Pehlivanoglu, Seckin; 32628147; AAE-1392-2021Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction <= 40%). Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019. Results: The study included 1462 outpatients (male: 70.1%, mean age: 67 +/- 11 years, mean LVEF: 30%+/- 6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279). Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.Item Pericarditis due to an unusual microorganism in an immunocompromised patient(2019) Ozkalayci, Flora; Aydin, Mehtap; Altay, Hakan; Kocabas, Umut; Pehlivanoglu, Seckin; 0000-0001-6424-9399; 31483309; AAG-5856-2020A 77-year-old man with a past medical history of myelodysplastic syndrome, coronary artery disease, hypertension, and chronic atrial fibrillation presented at the hematology outpatient clinic with progressive shortness of breath, weakness, and chest and back pain. Echocardiography was performed and the patient was diagnosed with severe pericardial effusion near the right ventricle. Pericardial drainage was performed. Erysipelothrix rhusiopathiae was isolated from the pericardial fluid. Complications of respiratory and renal failure developed during follow-up. The clinical and laboratory findings of vegetation on the tricuspid valve, pericardial effusion, and atrial fibrillation with a low heart rate suggested possible pancarditis. A multidisciplinary treatment approach with the cardiology and infectious disease departments was critical to successful management of this case.Item Early Changes in Atrial Electromechanical Coupling in Patients with Hypertension: Assessment by Tissue Doppler Imaging(2016) Avci, Burcak Kilickiran; Gulmez, Oyku; Donmez, Guclu; Pehlivanoglu, Seckin; 27231168Background: Hypertension (HT) is associated with atrial electrophysiological abnormalities. Echocardiographic pulsed wave tissue Doppler imaging (TDI) is one of the noninvasive methods for evaluation of atrial electromechanical properties. The aims of our study were to investigate the early changes in atrial electromechanical conduction in patients with HT and to assess the parameters that affect atrial electromechanical conduction. Methods: Seventy-six patients with HT (41 males, mean age 52.6 +/- 9.0 years) and 41 controls (22 males, mean age 49.8 +/- 7.9 years) were included in the study. Atrial electromechanical coupling at the right (PRA), left (PLA), interatrial septum (PIS) were measured with TDI. Intra- (right: PIS-PRA, left: PLA-PIS) and inter-atrial (PLA-PRA) electromechanical delays were calculated. Maximum P-wave duration (Pmax) was calculated from 12-lead electrocardiogram. Results: Atrial electromechanical coupling at PLA (76.6 +/- 14.1 ms vs. 82.9 +/- 15.8 ms, P = 0.036), left intra-atrial (10.9 +/- 5.0 ms vs. 14.0 +/- 9.7 ms, P = 0.023), right intra-atrial (10.6 +/- 7.8 ms vs. 14.5 +/- 10.1 ms, P = 0.035), and interatrial electromechanical (21.4 +/- 9.8 ms vs. 28.3 +/- 12.7 ms, P = 0.003) delays were significantly longer in patients with HT. The linear regression analysis showed that left ventricular (LV) mass index and Pmax were significantly associated with PLA (P = 0.001 and P = 0.002, respectively), and the LV mass index was the only related factor for interatrial delay (P = 0.001). Conclusions: Intra- and interatrial electromechanical delay, PLA were significantly prolonged in hypertensive patients. LV mass index and Pmax were significantly associated with PLA, and the LV mass index was the only related factor for interatrial delay. The atrial TDI can be a valuable method to assess the early changes of atrial electromechanical conduction properties in those patients.Item Clinical characteristics and outcomes of acute coronary syndrome patients with intra-aortic balloon pump inserted in intensive cardiac care unit of a tertiary clinic(2018) Pehlivanoglu, Seckin; Hayiroglu, Mert Ilker; Canga, Yigit; Yildirimtürk, Ozlem; Bozbeyoglu, Emrah; Gumusdag, Ayca; Uzun, Ahmet Okan; Kalenderoglu, Koray; Keskin, Muhammed; Cinier, Goksel; Acarel, Murat; 29339686; ABC-9264-2021Objective: An intra-aortic balloon pump (IABP) is a mechanical support device that is used in addition to pharmacological treatment of the failing heart in intensive cardiac care unit (ICCU) patients. In the literature, there are limited data regarding the clinical characteristics and in-hospital outcomes of acute coronary syndrome patients in Turkey who had an IABP inserted during their ICCU stay. This study is an analysis of the clinical characteristics and outcomes of these acute coronary syndrome patients. Methods: The data of patients who were admitted to the ICCU between September 2014 and March 2017 were analyzed retrospectively. The data were retrieved from the ICCU electronic database of the clinic. A total of 142 patients treated with IABP were evaluated in the study. All of the patients were in cardiogenic shock following percutaneous coronary intervention, at the time of IABP insertion. Results: The mean age of the patients was 63.0 +/- 9.7 years and 66.2% were male. In-hospital mortality rate of the study population was 54.9%. The patients were divided into 2 groups, consisting of survivors and non-survivors of their hospitalization period. Multivariate analysis after adjustment for the parameters in univariate analysis revealed that ejection fraction, Thrombolysis in Myocardial Infarction flow score of <= 2 after the intervention, chronic renal failure, and serum lactate and glucose levels were independent predictors of in-hospital mortality. Conclusion: The mortality rate remains high despite IABP support in patients with acute coronary syndrome. Patients who are identified as having a greater risk of mortality according to admission parameters should be further treated with other mechanical circulatory support devices.