Türk Nöroloji Dergisi (Sep 2023)

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

  • Mehmet Akif Topçuoğlu,
  • Ethem Murat Arsava,
  • Atilla Özcan Özdemir,
  • Özlem Aykaç,
  • Mustafa Çetiner,
  • Elif Sarıönder Gencer,
  • Aygül Güneş,
  • Yakup Krespi,
  • Erdem Yaka,
  • Levent Öcek,
  • Zeynep Tanrıverdi,
  • Ülgen Yalaz Tekan,
  • Ayça Özkul,
  • Esra Özkan,
  • Hadiye Şirin,
  • Ayşe Güler,
  • Oğuzhan Kurşun,
  • Refik Kunt,
  • Utku Cenikli,
  • Bilgehan Acar,
  • Yüksel Kablan,
  • Ayşe Yılmaz,
  • Canan Togay Işıkay,
  • Eda Aslanbaba,
  • Mine Sorgun,
  • Hesna Bektaş,
  • Murat Çabalar,
  • Vildan Yayla,
  • Hacı Ali Erdoğan,
  • Mustafa Gökçe,
  • Songül Bavli,
  • Nedim Ongun,
  • Ahmet Onur Keskin,
  • Özlem Akdoğan,
  • Ufuk Emre,
  • Özlem Kayım Yıldız,
  • Aslı Bolayır,
  • Çetin Kürşad Akpınar,
  • Hasan Hüseyin Karadeli,
  • Tuğba Özel,
  • Ali Ünal,
  • Babür Dora,
  • Zülfikar Arlıer,
  • Alper Eren,
  • Aysel Milanoğlu,
  • Bijen Nazliel,
  • Hale Batur Çağlayan,
  • Bülent Güven,
  • Mücahid Erdoğan,
  • Zeynep Özdemir Acar,
  • Mustafa Bakar,
  • Semih Giray,
  • Songül Şenadım,
  • Talip Asil,
  • Turgay Demir,
  • Yaprak Özüm Ünsal,
  • Neslihan Eşkut,
  • Yıldız Aslan,
  • Demet Funda Baş,
  • Ufuk Şener,
  • Bahar Değirmenci,
  • Ufuk Aluçlu,
  • Birgül Baştan,
  • Zeynep Acar,
  • Buket Niflioğlu,
  • Duran Yazıcı,
  • Emrah Aytaç,
  • Fatma Birsen İnce,
  • Halil Ay,
  • Halil Önder,
  • Hasan Hüseyin Kozak,
  • İrem İlgezdi,
  • Adnan Burak Bilgiç,
  • Şenol Akyol,
  • İ. Levent Güngör,
  • Murat Mert Atmaca,
  • Mustafa Şen,
  • Recep Yevgi,
  • Sinem Yazıcı Akkaş,
  • Tahir Yoldaş,
  • H. Tuğrul Atasoy,
  • Bilge Piri Çınar,
  • Arda Yılmaz,
  • Hamit Genç,
  • Ayşın Kısabay,
  • Faik İlik,
  • Hayri Demirbaş,
  • İpek Midi,
  • Pınar Bekdik Şirinocak,
  • Taşkın Duman,
  • Tülin Demir,
  • Ufuk Can,
  • Vedat Ali Yürekli,
  • Zehra Bozdoğan,
  • Zekeriya Alioğlu,
  • Dilaver Kaya,
  • Nazire Afşar,
  • Erdem Gürkaş,
  • Eren Toplutaş,
  • Eylem Değirmenci,
  • Gülseren Büyükşerbetçi,
  • İsa Aydın,
  • M. Tuncay Epçeliden,
  • Nilda Turgut,
  • Nilüfer Kale,
  • Eda Çoban,
  • Nilüfer Yeşilot,
  • Esme Ekizoğlu,
  • Özgü Kizek,
  • Özlem Bilgili,
  • Recep Baydemir,
  • Merve Akçakoyunlu,
  • Zahide Yılmaz,
  • Şerefnur Öztürk

DOI
https://doi.org/10.4274/tnd.2023.99492
Journal volume & issue
Vol. 29, no. 3
pp. 183 – 189

Abstract

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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 our country. Within the scope of NeuroTek-Turkey, hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute stroke algorithms. Materials and Methods: 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 Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. 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 ≥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: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, 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 Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. 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 AF.

Keywords