Evaluation of the demographic characteristics of patients who had an ischemic stroke while using non-vitamin K antagonist oral anticoagulant.

Öz

Aim: In this study, we aimed to evaluate the demographic characteristics of patients who had an ischemic stroke while using non-vitamin K antagonist oral anticoagulants (NOAC). Materials and Methods: Patients who had an ischemic stroke while using NOACs between January 2015 and January 2020 were included in the study. Patients and their relatives were called by phone and their file records were used to obtain their age, gender, comorbidities, NOAC use, routine biochemical and haematological parameters and transthoracic echocardiography information. Results: The study included 73 patients diagnosed with non-valvular atrial fibrillation (AF) who had a stroke while using NOACs. Of these patients, 23 (31.5%) were male and 50 (68.5%) were female. The mean age of the patients was 74.6±10 years. The mean CHA2DS2-VASc score was 5.6±1.5. Of the patients, 34 (46.6%) had recurrent strokes. All patients had vascular disease. Sixty-seven (91.8%) patients had hypertension. Twenty-one patients who were receiving NOACs were found to be receiving the NOACs at doses not recommended by the current guidelines. The mean age was higher and the CHA2DS2-VASc score was lower in patients who did not receive the appropriate dose compared to those who did receive the appropriate dose. The history of ischemic stroke was lower in patients who did not receive the appropriate dose compared to those who did receive the appropriate dose. Conclusion: The high CHA2DS2-VASc score of patients who had a stroke despite treatment with NOACs, the presence of vascular disease in all of them, the presence of hypertension in the majority and a history of ischemic stroke in almost half of these patients all suggest that NOAC treatment may be insufficient in patients with the high risk factors of vascular disease, hypertension and a history of ischemic stroke. In addition, the reasons why about one third of patients use NOACs at an insufficient dose needs to be investigated. These data should be evaluated by studies conducted with larger numbers of patients. Keywords: Atrial fibrillation, non-vitamin K antagonist oral anticoagulant, stroke Amaç: Biz bu çalışmamızda yeni nesil oral antikoagulan (YOAK) kullananırken iskemik inme geçiren atriyal fibrilasyonlu (AF) hastaların demografik özelliklerini değerlendirmeyi amaçladık. Materyal ve Metod: 2015 ocak ve 2020 ocak ayları arasında YOAK kullanırken iskemik inme geçiren hastalar çalışmaya dahil edilmiştir. Hastalar ve yakınları telefonla aranarak ve dosya kayıtları üzerinden hastaların yaş, cinsiyet bilgileri, eşlik eden hastalıklar, YOAK kullanımı, rutin biyokimyasal ve hematolojik parametreler ile transtorasik ekokardiyografi bilgilerine ulaşıldı. Bulgular: Non-valvüler AF tanılı ve yeni nesil oral antikoagulan kullanırken inme geçieren 73 kişi çalışmaya alındı. Hastaların 23’ü (% 31.5) erkek ve 50’si (% 68.5) kadın bireylerden oluşmaktaydı. Hastaların yaş ortalaması 74.6±10 yıldı. Ortalama CHA2DS2-VASc skoru 5.6±1.5 olarak bulundu. Hastaların 34 (% 46.6) tanesi tekrarlayan inmeydi. Altmış yedi (91.8%) hastanın hipertansiyonu vardı. Hastalardan 21 tanesi uygun dozda YOAK kullanmıyordu. Hastaların tamamında vasküler hastalık mevcuttu. Uygun dozda kullanmayanların uygun dozda kullananlara göre yaş ortalamasının daha yüksek olup CHA2DS2-VASc skorunun daha düşük olduğu gözlendi. Uygun dozda kullanmayanlarda uygun dozda kullananlara göre daha az iskemik inme öyküsü vardı Sonuç: YOAK altında inme geçiren hastaların CHADS-VASc skorunun yüksek olması, tamamının vasküler hastalığı olması, büyük çoğunluğunun hipertansiyonu olması ve bu hastaların yaklaşık yarısında iskemik stroke öyküsü olması nedeniyle, YOAK tedavisi risk faktörü yüksek olan, vasküler hastalığı olan, hipertansiyonu ve iskemik stroke öyküsü olan hastalarda yetersiz kalıyor olabilir. Ayrıca artan yaşla birlikte hastaların yaklaşık üçte birinde yetersiz dozda YOAK kullanmakta olup nedenlerinin araştırılması gerekir. Bu verilerin çok sayıda hasta alınan çalışmalar ile değerlendirilmesi gerekir. Anahtar Kelimeler: Atriyal fibrilasyon, yeni nesil oral antikoagulan, inme

Anahtar Kelimeler

• Atrial fibrillation,non-vitamin K antagonist oral anticoagulant,stroke

Kaynakça

1. References
2. 1. Mackay J, Mensah GA, Greenlund K. The atlas of heart disease and stroke: World Health Organization; 2004.
3. 2. Fisher M. Stroke and TIA: Epidemiology, Risk Factors, and the Need for Early Intervention. Am J Manag Care. 2008; 14: 204-211.
4. 3. Macle L, Cairns J, Leblanc K, Tsang T, et al. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. Can J Cardiol. 2016;32:1170-85.
5. 4. Camm AJ, Lip GY, De Caterina R, Savelieva I, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33:2719–47.
6. 5. Lip GY, Nieuwlaat R, Pisters R, Lane DA, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro heart survey on atrial fibrillation. Chest. 2010;137:263-72.
7. 6. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893-2962.
8. 7. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, et al. Dabigatran vs. warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-1151.

9. 8. Granger CB, Alexander JH, McMurray JJ, Lopes RD, et al. Apixaban vs. warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-992.
10. 9. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093–2104.
11. 10. Patel MR, Mahaffey KW, Garg J, Pan G, et al. Rivaroxaban vs. warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-891.
12. 11. Heidbuchel H, Verhamme P, Alings M, Antz M, et al. Updated European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. Eur Heart J. 2017;38:2137-2149. 12. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, et al. Projections on the number of individual swith atrial fibrillation in the European Union, from 2000 to 2060. EurHeart J. 2013;34:2746–51.
13. 13. Hart RG. What’s new in stroke? The top 10 studies of 2006-2008. Part I. Pol Arch Med Wewn. 2008;118:650-7.
14. 14. Andersen KK, Olsen TS. Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants Results From a Danish Quality-Control Registry of 22 179 Patients With Ischemic Stroke. Stroke. 2007;38:259-263.
15. 15. Béjot Y, Ben Salem D, Osseby GV, Couvreur G, et al. Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006. Neurology 2009;72:346-53.
16. 16. Uludüz D, İnce B. Secondary prevention of cardioembolic strokes (Kardiyoembolik inmelerin ikincil korunması). cf: Kumral E, editor. Vascular Diseases of the Central Nervous System (Santral Sinir Sisteminin Damarsal Hastalıkları). Ankara: Güneş Medical Publishing (Güneş Tıp Kitabevleri); 2011. p. 1055-66.
17. 17. Ansell J, Hirsh J, Poller L, Bussey H, et al. Thepharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:204-233.
18. 18. Furie KL, Goldstein LB, Albers GW, Khatri P, et al. Oral antithrombotic agents for the prevention of stroke in non valvular atrial fibrillation: a science advisory for health care professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43: 3442-53.
19. 19. Lansberg MG, O’Donnell MJ, Khatri P, Lang ES, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:601S-636S..