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    Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study
    (Galenos Publ House, 2023) Topcuoglu, Mehmet Akif; Arsava, Ethem Murat; Ozdemir, Atilla Ozcan; Aykac, Ozlem; Cetiner, Mustafa; Gencer, Elif Sarioender; Gunes, Aygul
    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 Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.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: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, 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 Turkiye. 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.
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    Do antiepileptic drugs cause premature atherosclerosis by disturbing lipid metabolism?
    (Bayrakol Medical Publisher, 2022) Eskut, Neslihan; Soysuren, Cagla; Dogan, Gulec Mert; Tuna, Gamze; Toksoz, Feriha; Calis, Nazif; Cetiner, Mustafa
    Aim: The aim of this study was to evaluate susceptibility to atherosclerosis in epileptic patients on carbamazepine and valproic acid monotherapy with lipid profile, lipoprotein (a) (lp(a)), oxidized low-density lipoprotein (LDL), adiponectin, and carotid artery intima-media thickness measurements. Material and Methods: Of the 108 patients with epilepsy included in the study, 64 (36 female, 28 male) were receiving valproic acid monotherapy and 44 (25 female, 19 male) were receiving carbamazepine monotherapy. The control group comprised 48 (30 female, 18 male) healthy participants. Liver and kidney function tests, cholesterol, triglycerides, LDL, high-density lipoprotein (HDL), lp(a), oxidized LDL, adiponectin, and common carotid (CCA) and internal carotid artery (ICA) intima-media thickness (IMT) were investigated in both the patient and control groups. Results: Mean age was 32.34 +/- 12.41 years in the valproic acid group, 32.70 +/- 11.64 years in the carbamazepine group, and 35.81 +/- 11.76 years in the control group. Liver and kidney function test results were normal in all groups. Cholesterol levels were lower in the valproic acid group than the other groups. HDL levels were higher in the carbamazepine group than other groups. Adiponectin levels were lower in the valproic acid group. In all groups, cholesterol and LDL levels were higher in individuals older than 50 years old. When the patients were evaluated according to the duration of drug use, cholesterol and LDL levels were higher in patients who had used drugs for more than 5 years in the valproic acid group. There were no differences between the groups for triglyceride, oxidized LDL, or lp(a) levels or CCA and ICA IMT. Discussion: There are conflicting results in the literature regarding epilepsy and atherosclerosis associated with antiepileptic drug usage. In this study, no evidence was found of an increasing risk of arteriosclerosis associated with antiepileptic drugs by measuring lipids, lipoprotein, oxidized LDL, adiponectin levels, and CCA and ICA IMT. However, it is important to monitor lipid levels in the follow-up of patients with epilepsy, especially for patients requiring longterm antiepileptic therapy and also older patients.