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    Anticoagulants in left atrial thrombus resolution
    (2020) Yilmaz, Kerem Can; Ciftci, Orcun; Ozin, Bulent; Muderrisoglu, Haldun
    Aim: Warfarin has been used for protection from peripheral embolism in patients with atrial fibrillation (AF) and it has been shown that the direct oral anticoagulants are effective in protection against stroke as much as warfarin and cause lower bleeding complications. Our aim is to compare the efficacies of different anticoagulants in resolution of left atrial appendage thrombi.Materials and Methods: 264 patients were included in study. 39 patients had left atrial appendage thrombus; 17 patients underwent a repeat transesophageal echocardiography (TEE) after switching/administering an anticoagulant treatment regimen.Results: Thrombus was detected in 3 patients using apixaban, who were switched to dabigatran. Those patients were found to have thrombus resolution by the repeat TEE procedures. Of 5 patients using warfarin, 3 were switched to dabigatran, in one of whom thrombus resolution was not achieved. One patient continued warfarin with a target INR of 2.5-3.5 and a repeat TEE showed complete thrombus resolution. The remainder patient using warfarin was swithed to rivaroxaban, with complete thrombus resolution having been achieved. Two patients using edoxaban had their thrombi resolved by dabigatran. Seven patients were not receiving any anticoagulant regimen. Among these, warfarin was administered to 4 patients and apixaban to 2; repeat TEEs showed no thrombus. The remainder patient was administered low molecular weight heparin, and repeat TEE showed persistence of LAA thrombus.Conclusion: Irrespective of patients being anticoagulated, TEE should be planned before interventional procedures and cardioversion. If thrombus develops in a patient receiving anticoagulant treatment, switching to a different anticoagulant would be a logical option.
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    Risk factors for coronary artery disease in left bundle branch block
    (2019) Yilmaz, Kerem Can; Keskin, Suzan; Ciftci, Orcun; Ozin, Bulent; Muderrisoglu, Haldun
    Aim: The presence of left bundle branch block (LBBB) in the surface electrocardiogram makes the evalaution of patients for suspected angina pectoris difficult. A newly developed LBBB in patients with acute chest pain is an indication for primary percutaneous coronary intervention. However, it is difficult to evaluate the coronary artery disease (CAD) in stable patients with LBBB. In this study, we aimed to investigate the baseline demographic characteristics, electrocardiographic and echocardiographic findings in LBBB patients who had a preliminary diagnosis of CAD. Material and Methods: We enrolled a total of 216 consecutive patients with a LBBB who had undergone coronary angiography. Of these patients, severe coronary artery disease did not find in 123 (56%) patients, while 93 (44%) patients had severe coronary artery disease Results: The frequency of male sex, diabetes mellitus and hyperlipidemia were significantly higher in the CAD group (p=0.007, p=0.001, and p=0.012, respectively). Comparasion of electrocardiographic findings revealed no significant difference betweent the goups. In terms of the echocardiography findings, the left venticular ejection fraction was significantly lower and the left venticular end-diastolic volume was significantly higher in patients with CAD. We noted that patients with CAD had significiantly elevated creatinine levels compared to those who did not. Conclusion: The significant risk factors for CAD among patients with LBBB included diabetes mellitus, elevated creatinine levels, male sex, advanced age, and low left venticular ejection fraction. These risk factors should be incorporated with non-invasive tests in patients with who had a preliminary diagnosis of CAD, and a conventional angiography should be considered in these patients in an attempt to increase the specificity and sensitivity of the available diagnostic tests.