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    Intra-aortic balloon pump-related thrombocytopenia: Its effects on in-hospital mortality in cardiogenic shock patients
    (2019) Hayiroglu, Mert Ilker; Cinar, Tufan; Tekkesin, Ahmet Ilker
    Aim: The present study aimed to evaluate the potential role of intra-aortic balloon pump (IABP)-related thrombocytopenia in patients with cardiogenic shock (CS) due to ST elevation myocardial infarction (STEMI) dien in hospital.Material and Methods: We retrospectively included 142 consecutive CS patients who were treated with IABP support from September 2013 to March 2017 in a tertiary heart center. IABP-related thrombocytopenia was defined as a platelet count of 150.000 mm3 or a 50% or greater reduction in the platelet count from the baseline following the IABP’s insertion. In-hospital, all-cause mortality was the primary endpoint.Results: The incidence rate of thrombocytopenia was 19% (n=27 patients). In-hospital mortality was significantly higher in patients who experienced thrombocytopenia compared to those who did not [22 patients (81.5%) vs. 56 patients (48.7%), respectively; p=0.004]. In a multivariate analysis, a decline in platelet count (OR: 1.037, 95%; CI: 1.011–1.064; p=0.005) was found to be independently associated with in-hospital mortality. In a receiver operating characteristic curve analysis, the optimal cut-off value of the decline in platelet count for the prediction of in-hospital mortality was ≥ 18.2%, with a sensitivity of 60% and a specificity of 77% [area under curve (AUC): 0.70, 95%; CI:0.61–0.78; p0.001].Conclusion: In the present study, we observed that the development of thrombocytopenia during IABP support was independently associated with in-hospital mortality in CS patients.Keywords: Intra-aortic balloon pump; thrombocytopenia; cardiogenic shock; in-hospital mortality.
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    The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study
    (Galenos Publ House, 2017) Kilic, Salih; Celik, Ahmet; Cakmak, Huseyin Altug; Afsin, Abdulmecit; Tekkesin, Ahmet Ilker; Aciksari, Gonul; Memetoglu, Mehmet Erdem
    Background: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. Aims: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. Study Design: Cross-sectional study. Methods: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal's algorithm. Awareness was evaluated based on the patients' knowledge of the effect of warfarin and fooddrug interactions with simple questions developed based on a literature review. Results: The Turkey-wide time in therapeutic range was reported as 49.5% +/- 22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p<0.001). The highest rate was reported in the Marmara region (54.99%+/- 20.91) and the lowest was in the South-eastern Anatolia region (41.95 +/- 24.15) (p< 0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p< 0.001). Conclusion: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey.