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(0000000263543550); 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(0000000286564581); 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:10.4274/tnd.2023.99492

Mehmet Akif Topçuoğlu¹, Ethem Murat Arsava¹, Atilla Özcan Özdemir², Özlem Aykaç², Mustafa Çetiner³, Elif Sarıönder Gencer⁴, Aygül Güneş⁵, Yakup Krespi⁶, Erdem Yaka⁷, Levent Öcek⁸, Zeynep Tanrıverdi⁹, Ülgen Yalaz Tekan⁹, Ayça Özkul¹⁰, Esra Özkan¹¹, Hadiye Şirin¹², Ayşe Güler¹², Oğuzhan Kurşun¹³, Refik Kunt¹⁴, Utku Cenikli¹⁵, Bilgehan Acar¹⁶, Yüksel Kablan¹⁷, Ayşe Yılmaz¹⁸(0000000263543550), Canan Togay Işıkay¹⁹, Eda Aslanbaba¹⁹, Mine Sorgun¹⁹, Hesna Bektaş¹³, Murat Çabalar²⁰, Vildan Yayla²⁰, Hacı Ali Erdoğan²⁰, Mustafa Gökçe²¹, Songül Bavli²¹, Nedim Ongun²², Ahmet Onur Keskin²³, Özlem Akdoğan²⁴(0000000286564581), Ufuk Emre²⁴, Özlem Kayım Yıldız²⁵, Aslı Bolayır²⁵, Çetin Kürşad Akpınar²⁶, Hasan Hüseyin Karadeli²⁷, Tuğba Özel²⁸, Ali Ünal²⁸, Babür Dora²⁸, Zülfikar Arlıer²⁹, Alper Eren³⁰, Aysel Milanoğlu³¹, Bijen Nazliel³², Hale Batur Çağlayan³², Bülent Güven³³, Mücahid Erdoğan³⁴, Zeynep Özdemir Acar³⁴, Mustafa Bakar³⁵, Semih Giray³⁶, Songül Şenadım³⁷, Talip Asil³⁸, Turgay Demir³⁹, Yaprak Özüm Ünsal⁴⁰, Neslihan Eşkut⁴⁰, Yıldız Aslan⁴¹, Demet Funda Baş⁴¹, Ufuk Şener⁴¹, Bahar Değirmenci⁴², Ufuk Aluçlu⁴², Birgül Baştan⁴³, Zeynep Acar⁴³, Buket Niflioğlu⁴⁴, Duran Yazıcı⁴⁵, Emrah Aytaç⁴⁶, Fatma Birsen İnce⁴⁷, Halil Ay⁴⁸, Halil Önder⁴⁹, Hasan Hüseyin Kozak⁵⁰, İrem İlgezdi⁵¹, Adnan Burak Bilgiç⁵¹, Şenol Akyol⁵¹, İ. Levent Güngör⁵², Murat Mert Atmaca⁵³, Mustafa Şen⁵⁴, Recep Yevgi⁵⁵, Sinem Yazıcı Akkaş⁵⁶, Tahir Yoldaş⁵⁷, H. Tuğrul Atasoy⁵⁸, Bilge Piri Çınar⁵⁸, Arda Yılmaz⁵⁹, Hamit Genç⁵⁹, Ayşın Kısabay⁶⁰, Faik İlik⁶¹, Hayri Demirbaş⁶², İpek Midi⁶³, Pınar Bekdik Şirinocak⁶⁴, Taşkın Duman⁶⁵, Tülin Demir⁶⁶, Ufuk Can⁶⁷, Vedat Ali Yürekli⁶⁸, Zehra Bozdoğan⁶⁹, Zekeriya Alioğlu⁷⁰, Dilaver Kaya⁷¹, Nazire Afşar⁷¹, Erdem Gürkaş⁷², Eren Toplutaş⁷³, Eylem Değirmenci⁷⁴, Gülseren Büyükşerbetçi⁷⁵, İsa Aydın⁷⁶, M. Tuncay Epçeliden⁷⁷, Nilda Turgut⁷⁸, Nilüfer Kale⁷⁹, Eda Çoban⁷⁹, Nilüfer Yeşilot⁸⁰, Esme Ekizoğlu⁸⁰, Özgü Kizek⁸⁰, Özlem Bilgili⁸¹, Recep Baydemir⁸², Merve Akçakoyunlu⁸², Zahide Yılmaz⁸³, Şerefnur Öztürk⁸⁴

¹Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Türkiye
²Eskisehir Osmangazi University Faculty of Medicine, Department of Neurology, Eskisehir, Türkiye
³Dumlupinar University Faculty of Medicine, Department of Neurology, Kutahya, Türkiye
⁴University of Health Sciences Türkiye, Antalya Training and Research Hospital, Clinic of Neurology, Antalya, Türkiye
⁵University of Health Sciences Türkiye, Bursa Yuksek Ihtisas Training and Research Hospital, Stroke Unit, Bursa, Türkiye
⁶Istanbul Aydin University Faculty of Medicine; VM Florya Medical Park Hospital; Comprehensive Stroke Center; Istanbul and Istinye University; Bahcesehir Liv Hospital; Pendik Medical Park Hospital; Department of Neurology, Istanbul Türkiye
⁷Dokuz Eylül University Faculty of Medicine, Department of Neurology, Izmir, Türkiye
⁸Usak State Hospital, Clinic of Neurology, Usak, Türkiye
⁹University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
¹⁰Aydin Adnan Menderes University Faculty of Medicine, Department of Neurology, Aydin, Türkiye
¹¹Tokat State Hospital, Clinic of Neurology, Tokat, Türkiye
¹²Ege University Faculty of Medicine, Department of Neurology, Izmir, Türkiye
¹³Ankara Bilkent City Hospital, Clinic of Neurology, Ankara, Türkiye
¹⁴Aydin State Hospital, Clinic of Neurology, Aydin, Türkiye
¹⁵Mugla Sitki Kocman University Faculty of Medicine, Department of Neurology, Mugla, Türkiye
¹⁶Sakarya University Faculty of Medicine, Department of Neurology, Sakarya, Türkiye
¹⁷Inonu University Faculty of Medicine, Department of Neurology, Malatya, Türkiye
¹⁸Bakirkoy Psychiatric and Nervous Diseases Hospital, Clinic of 2nd Neurology, Istanbul, Türkiye
¹⁹Ankara University Faculty of Medicine, Department of Neurology, Ankara, Türkiye
²⁰University of Health Sciences Türkiye, Istanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
²¹Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Neurology, Kahramanmaras, Türkiye
²²Burdur State Hospital, Clinic of Neurology, Burdur, Türkiye
²³Eskisehir Yunus Emre State Hospital, Clinic of Neurology, Eskisehir, Türkiye
²⁴University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
²⁵Sivas Cumhuriyet University Faculty of Medicine, Department of Neurology, Sivas, Türkiye
²⁶Samsun Training and Research Hospital, Clinic of Neurology, Samsun, Türkiye
²⁷Istanbul Medeniyet University Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
²⁸Akdeniz University Faculty of Medicine, Department of Neurology, Antalya, Türkiye
²⁹Baskent University, Adana Application and Research Center, Department of Neurology, Adana, Türkiye
³⁰Ataturk University Research Hospital, Clinic of Neurology, Erzurum, Türkiye
³¹Van Yuzuncu Yil University Faculty of Medicine, Department of Neurology, Van, Türkiye
³²Gazi University Faculty of Medicine, Department of Neurology, Ankara, Türkiye
³³University of Health Sciences Türkiye, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Neurology, Ankara, Türkiye
³⁴Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Neurology Intensive Care Unit, Istanbul, Türkiye
³⁵Bursa Uludag University Faculty of Medicine, Department of Neurology, Bursa, Türkiye
³⁶Gaziantep University Faculty of Medicine, Department of Neurology, Gaziantep, Türkiye
³⁷Bakirkoy Psychiatric and Nervous Diseases Hospital, Clinic of 1st Neurology, Istanbul, Türkiye
³⁸Memorial Hizmet Hospital, Clinic of Neurology, Istanbul, Türkiye
³⁹Cukurova University Faculty of Medicine, Department of Neurology, Adana, Türkiye
⁴⁰University of Health Sciences Türkiye, Izmir Bozyaka Training and Research Hospital, Clinic of Neurology, İzmir, Türkiye
⁴¹University of Health Sciences Türkiye, Izmir Tepecik Training and Research Hospital, Clinic of Neurology, İzmir, Türkiye
⁴²Dicle University Faculty of Medicine, Department of Neurology, Diyarbakir, Türkiye
⁴³University of Health Sciences Türkiye, Istanbul Haseki Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
⁴⁴Mus State Hospital, Clinic of Neurology, Mus, Türkiye
⁴⁵Ordu State Hospital, Clinic of Neurology, Ordu, Türkiye
⁴⁶Firat University Faculty of Medicine, Department of Neurology, Elazıg, Türkiye
⁴⁷Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
⁴⁸Harran University Faculty of Medicine, Department of Neurology, Sanliurfa, Türkiye
⁴⁹Yozgat City Hospital, Clinic of Neurology, Yozgat, Türkiye
⁵⁰Necmettin Erbakan University Meram Faculty of Medicine, Department of Neurology, Konya, Türkiye
⁵¹Giresun University Faculty of Medicine, Department of Neurology, Giresun, Türkiye
⁵²Ondokuz Mayis University Faculty of Medicine, Department of Neurology, Samsun, Türkiye
⁵³University of Health Sciences Türkiye, Sultan 2nd Abdulhamid Han Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
⁵⁴Yalova State Hospital, Clinic of Neurology, Yalova, Türkiye
⁵⁵Erzurum Regional Training and Research Hospital, Clinic of Neurology, Erzurum, Türkiye
⁵⁶University of Health Sciences Türkiye, Istanbul Bagcilar Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
⁵⁷Ankara Training and Research Hospital, Clinic of Neurology, Ankara, Türkiye
⁵⁸Zonguldak Bulent Ecevit University Faculty of Medicine, Department of Neurology, Zonguldak, Türkiye
⁵⁹Mersin University Faculty of Medicine, Department of Neurology, Mersin, Türkiye
⁶⁰Manisa Celal Bayar University Faculty of Medicine, Department of Neurology, Manisa, Türkiye
⁶¹Konya Medicana Hospital, Clinic of Neurology, Konya, Türkiye
⁶²Afyon Kocatepe University Faculty of Medicine, Department of Neurology, Afyon, Türkiye
⁶³Marmara University Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
⁶⁴University of Health Sciences Türkiye, Kocaeli Derince Training and Research Hospital, Clinic of Neurology, Kocaeli, Türkiye
⁶⁵Mustafa Kemal University Faculty of Medicine, Department of Neurology, Hatay, Türkiye
⁶⁶Sanliurfa Training and Research Hospital, Clinic of Neurology, Sanliurfa, Türkiye
⁶⁷Baskent University Faculty of Medicine, Department of Neurology, Ankara, Türkiye
⁶⁸Suleyman Demirel University Faculty of Medicine, Department of Neurology, Afyon, Türkiye
⁶⁹Kars Harakani State Hospital, Clinic of Neurology, Kars, Türkiye
⁷⁰Karadeniz Technical University Faculty of Medicine, Department of Neurology, Trabzon, Türkiye
⁷¹Acibadem University Faculty of Medicine; Altunizade Hospital, Department of Neurology, Istanbul, Türkiye
⁷²University of Health Sciences Türkiye, Gulhane Training and Research Hospital, Clinic of Neurology, Ankara, Türkiye
⁷³Istanbul Medipol University Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
⁷⁴Pamukkale University Faculty of Medicine, Department of Neurology, Denizli, Türkiye
⁷⁵Balikesir University Faculty of Medicine, Department of Neurology, Balikesir, Türkiye
⁷⁶Balikligol State Hospital, Clinic of Neurology, Sanliurfa, Türkiye
⁷⁷Kemer State Hospital, Clinic of Neurology, Antalya, Türkiye
⁷⁸Tekirdag Namik Kemal University Faculty of Medicine, Department of Neurology, Tekirdag, Türkiye
⁷⁹Istanbul Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Clinic of Neurology, Istanbul, Türkiye
⁸⁰Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
⁸¹Edirne State Hospital, Clinic of Neurology, Edirne, Türkiye
⁸²Erciyes University Faculty of Medicine, Department of Neurology, Kayseri, Türkiye
⁸³University of Health Sciences Türkiye, Kocaeli Derince Training and Research Hospital, Clinic of 1st Neurology, Kocaeli, Türkiye
⁸⁴Selcuk University Faculty of Medicine, Department of Neurology, Konya, Türkiye

Keywords: Acute stroke, transient ischemic attack, anticoagulant, relapse, therapeutic dose, Holter monitoring

Abstract

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: NöroTek^TR 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.

Ethics Committee Approval

Non-Interventional Ethics Committee of Hacettepe University Faculty of Medicine (date: 27/3/2018, no: 18/331).

Informed Consent

The authors have stated that they obtained signed consent for data sharing from the patients.

Peer Review

Externally peer-reviewed.

Author Contributions

Surgical and Medical Practices: All authors, Concept: M.A.T., E.M.A., A.Ö.Ö., Design: M.A.T., E.M.A., A.Ö.Ö., Data Collection or Processing: All authors, Analysis and Interpretation: M.A.T., E.M.A., A.Ö.Ö., Literature Search: M.A.T., Writing: M.A.T.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study received no financial support.