Atrial Fibrillation Management in Acute Stroke Patients in T�rkiye: Real-life Data from the N�roTek Study

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Volume : 29 Issue : 3 Year : 2023

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Turkish Journal of Neurology Indexed By

Atrial Fibrillation Management in Acute Stroke Patients in T�rkiye: Real-life Data from the N�roTek Study [Turk J Neurol]

Turk J Neurol. 2023; 29(3): 183-189 | DOI: 10.4274/tnd.2023.99492

Atrial Fibrillation Management in Acute Stroke Patients in T�rkiye: Real-life Data from the N�roTek Study

Mehmet Akif Top�uo�lu¹, Ethem Murat Arsava¹, Atilla �zcan �zdemir², �zlem Ayka�², Mustafa �etiner³, Elif Sar��nder Gencer⁴, Aygül Güne�⁵, Yakup Krespi⁶, Erdem Yaka⁷, Levent �cek⁸, Zeynep Tanr�verdi⁹, �lgen Yalaz Tekan⁹, Ay�a �zkul¹⁰, Esra �zkan¹¹, Hadiye �irin¹², Ay�e Güler¹², O�uzhan Kur�un¹³, Refik Kunt¹⁴, Utku Cenikli¹⁵, Bilgehan Acar¹⁶, Yüksel Kablan¹⁷, Ay�e Y�lmaz¹⁸, Canan Togay I��kay¹⁹, Eda Aslanbaba¹⁹, Mine Sorgun¹⁹, Hesna Bekta�¹³, Murat �abalar²⁰, Vildan Yayla²⁰, Hac� Ali Erdo�an²⁰, Mustafa G�k�e²¹, Songül Bavli²¹, Nedim Ongun²², Ahmet Onur Keskin²³, �zlem Akdo�an²⁴, Ufuk Emre²⁴, �zlem Kay�m Y�ld�z²⁵, Asl� Bolay�r²⁵, �etin Kür�ad Akp�nar²⁶, Hasan Hüseyin Karadeli²⁷, Tu�ba �zel²⁸, Ali �nal²⁸, Babür Dora²⁸, Zülfikar Arl�er²⁹, Alper Eren³⁰, Aysel Milano�lu³¹, Bijen Nazliel³², Hale Batur �a�layan³², Bülent Güven³³, Mücahid Erdo�an³⁴, Zeynep �zdemir Acar³⁴, Mustafa Bakar³⁵, Semih Giray³⁶, Songül �enad�m³⁷, Talip Asil³⁸, Turgay Demir³⁹, Yaprak �züm �nsal⁴⁰, Neslihan E�kut⁴⁰, Y�ld�z Aslan⁴¹, Demet Funda Ba�⁴¹, Ufuk �ener⁴¹, Bahar De�irmenci⁴², Ufuk Alu�lu⁴², Birgül Ba�tan⁴³, Zeynep Acar⁴³, Buket Niflio�lu⁴⁴, Duran Yaz�c�⁴⁵, Emrah Ayta�⁴⁶, Fatma Birsen �nce⁴⁷, Halil Ay⁴⁸, Halil �nder⁴⁹, Hasan Hüseyin Kozak⁵⁰, �rem �lgezdi⁵¹, Adnan Burak Bilgi�⁵¹, �enol Akyol⁵¹, �. Levent Güng�r⁵², Murat Mert Atmaca⁵³, Mustafa �en⁵⁴, Recep Yevgi⁵⁵, Sinem Yaz�c� Akka�⁵⁶, Tahir Yolda�⁵⁷, H. Tu�rul Atasoy⁵⁸, Bilge Piri ��nar⁵⁸, Arda Y�lmaz⁵⁹, Hamit Gen�⁵⁹, Ay��n K�sabay⁶⁰, Faik �lik⁶¹, Hayri Demirba�⁶², �pek Midi⁶³, P�nar Bekdik �irinocak⁶⁴, Ta�k�n Duman⁶⁵, Tülin Demir⁶⁶, Ufuk Can⁶⁷, Vedat Ali Yürekli⁶⁸, Zehra Bozdo�an⁶⁹, Zekeriya Alio�lu⁷⁰, Dilaver Kaya⁷¹, Nazire Af�ar⁷¹, Erdem Gürka�⁷², Eren Topluta�⁷³, Eylem De�irmenci⁷⁴, Gülseren Büyük�erbet�i⁷⁵, �sa Ayd�n⁷⁶, M. Tuncay Ep�eliden⁷⁷, Nilda Turgut⁷⁸, Nilüfer Kale⁷⁹, Eda �oban⁷⁹, Nilüfer Ye�ilot⁸⁰, Esme Ekizo�lu⁸⁰, �zgü Kizek⁸⁰, �zlem Bilgili⁸¹, Recep Baydemir⁸², Merve Ak�akoyunlu⁸², Zahide Y�lmaz⁸³, �erefnur �ztürk⁸⁴
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 Bak�rkoy 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, �zmir, Türkiye
⁴¹University of Health Sciences Türkiye, Izmir Tepecik Training and Research Hospital, Clinic of Neurology, �zmir, 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, Elaz�g, 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

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 T�rkiye. Within the scope of N�roTek-T�rkiye (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: N�roTekTR revealed the high but expected frequency of AF in acute stroke in T�rkiye, 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 T�rkiye. 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: Acute stroke, transient ischemic attack, anticoagulant, relapse, therapeutic dose, Holter monitoring

Mehmet Akif Top�uo�lu, Ethem Murat Arsava, Atilla �zcan �zdemir, �zlem Ayka�, Mustafa �etiner, Elif Sar��nder Gencer, Aygül Güne�, Yakup Krespi, Erdem Yaka, Levent �cek, Zeynep Tanr�verdi, �lgen Yalaz Tekan, Ay�a �zkul, Esra �zkan, Hadiye �irin, Ay�e Güler, O�uzhan Kur�un, Refik Kunt, Utku Cenikli, Bilgehan Acar, Yüksel Kablan, Ay�e Y�lmaz, Canan Togay I��kay, Eda Aslanbaba, Mine Sorgun, Hesna Bekta�, Murat �abalar, Vildan Yayla, Hac� Ali Erdo�an, Mustafa G�k�e, Songül Bavli, Nedim Ongun, Ahmet Onur Keskin, �zlem Akdo�an, Ufuk Emre, �zlem Kay�m Y�ld�z, Asl� Bolay�r, �etin Kür�ad Akp�nar, Hasan Hüseyin Karadeli, Tu�ba �zel, Ali �nal, Babür Dora, Zülfikar Arl�er, Alper Eren, Aysel Milano�lu, Bijen Nazliel, Hale Batur �a�layan, Bülent Güven, Mücahid Erdo�an, Zeynep �zdemir Acar, Mustafa Bakar, Semih Giray, Songül �enad�m, Talip Asil, Turgay Demir, Yaprak �züm �nsal, Neslihan E�kut, Y�ld�z Aslan, Demet Funda Ba�, Ufuk �ener, Bahar De�irmenci, Ufuk Alu�lu, Birgül Ba�tan, Zeynep Acar, Buket Niflio�lu, Duran Yaz�c�, Emrah Ayta�, Fatma Birsen �nce, Halil Ay, Halil �nder, Hasan Hüseyin Kozak, �rem �lgezdi, Adnan Burak Bilgi�, �enol Akyol, �. Levent Güng�r, Murat Mert Atmaca, Mustafa �en, Recep Yevgi, Sinem Yaz�c� Akka�, Tahir Yolda�, H. Tu�rul Atasoy, Bilge Piri ��nar, Arda Y�lmaz, Hamit Gen�, Ay��n K�sabay, Faik �lik, Hayri Demirba�, �pek Midi, P�nar Bekdik �irinocak, Ta�k�n Duman, Tülin Demir, Ufuk Can, Vedat Ali Yürekli, Zehra Bozdo�an, Zekeriya Alio�lu, Dilaver Kaya, Nazire Af�ar, Erdem Gürka�, Eren Topluta�, Eylem De�irmenci, Gülseren Büyük�erbet�i, �sa Ayd�n, M. Tuncay Ep�eliden, Nilda Turgut, Nilüfer Kale, Eda �oban, Nilüfer Ye�ilot, Esme Ekizo�lu, �zgü Kizek, �zlem Bilgili, Recep Baydemir, Merve Ak�akoyunlu, Zahide Y�lmaz, �erefnur �ztürk. Atrial Fibrillation Management in Acute Stroke Patients in T�rkiye: Real-life Data from the N�roTek Study. Turk J Neurol. 2023; 29(3): 183-189

Corresponding Author: Mehmet Akif Topcuoglu, T�rkiye

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