Yeni Nesil Oral Antikoagülan Kullanan İskemik İnme Hastalarında Risk Faktörleri

Öz

Amaç: Non-valvüler atriyal fibrilasyon (NVAF) iskemik inmenin en yaygın nedenidir. NVAF’ye bağlı inmeden primer korunma tedavisinde varfarin kullanılırken, son zamanlarda yeni nesil oral antikoagülanlar (YOAK) ilk tercih olmaktadır. YOAK kullanan hastalarda her yıl %1-2 iskemik inme görülmesi nedeniyle riskli hastaların belirlenmesi önemlidir. Bu çalışmada, YOAK kullanırken inme gelişen hastaların klinik özelliklerinin ve riski artıran faktörlerin belirlenmesi amaçlandı. Yöntemler: YOAK kullanırken inme geçiren hastalar ile kontrol grubunun demografik bilgileri, klinik özellikleri, laboratuvar ve radyolojik bulguları retrospektif olarak değerlendirildi. Bulgular: NVAF ilişkili ilk defa inme geçiren 35 hasta dosyasına ulaşıldı. Bu hastaların 13’ü YOAK kullanırken inme geçirmişti, 8’i (%61.5) erkek, 5’i (%39.5) kadın idi. Ortalama yaş 75±11 yıldı. Hastaların başvuru NIHSS’si kontrol grubuna göre yüksekti. TEE’de 3 hastada (%23.1) sol atriyal trombüs tespit edilmişti. Hasta grubunda trigliserit, nötrofil lenfosit oranı (NLO), nötrofil platelet oranı (NPO) ve türetilmiş NLO (dNLO) düzeylerinin kontrol grubuna göre yüksek olduğu bulundu. Sonuç: NVAF nedeniyle YOAK tedavisi alan hastalarda inme geliştiğinde, ilaç başarısızlığına sebep olabilecek sol atriyal trombüs ve konjestif kalp yetmezliği en çok bilinen risk faktörleridir. Bu çalışmada tespit edilen yüksek trigliserit, NLO ve NPO düzeyleri ise riskli hastaları belirlemede diğer önemli parametreler olup daha fazla hasta üzerinde prospektif olarak araştırılmalıdırlar.

Anahtar Kelimeler

• iskemik inme
• antikoagülan ilaçlar
• yeni nesil oral antikoagülanlar
• atriyal fibrilasyon

Kaynakça

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