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    Effect of Covid-19 pandemic process on STEMI patients timeline
    (Wiley-Hindawi, 2021) Soylu, Korhan; Coksevim, Metin; Yanik, Ahmet; Bugra Cerik, Idris; Aksan, Gokhan
    Objective: Delayed revascularisation in patients with ST-segment elevation myocardial infarction (STEMI) is associated with poor prognosis. The aim of this study is to investigate how the timeline in STEMI treatment was affected during the Covid-19 outbreak. Method: Consecutive 165 STEMI patients were enrolled in the study during the Covid-19 pandemic period (Pandemic period) and the prepandemic period (Control period). The time period until patients' leaving their current position after the onset of pain (home delay), the time from the onset of pain to the first medical contact (FMC delay), door-to-balloon time, procedure time and hospitalisation time were recorded. Results: A total of 165 patients, 82 in the Pandemic period and 83 in the Control period, were included in the study. When compared with the control period, home delay [30 (5-6912) minutes vs 165 (10-360) minutes, P < .001] and FMC delay [61 (20-6932) minutes vs 190 (15-3660) minutes, P < .001] were significantly prolonged during the pandemic period. In addition, non-IRA PCI rate (8.8% vs 19.3% P = .043) and hospitalisation time [71 (15-170) vs 74.2 (37-329) hours, P = .045] were decreased. Conclusion: During the Covid-19 pandemic period, prolonged prehospital time parameters were observed in STEMI patients. Therefore, additional measures may be required to prevent unfavourable delays in STEMI patients during the outbreak.
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    Evaluation of ivabradine in left ventricular dyssynchrony and reverse remodeling in patients with chronic heart failure
    (Wiley, 2020) Soylu, Korhan; Cerik, Idris Bugra; Aksan, Gokhan; Nar, Gokay; Meric, Murat
    Objectives: Ivabradine is a pharmacological agent used in patients with heart failure and sinus rhythm. Its only known pharmacological effect is to slow the heart rate. In this study, we investigated the impact of ivabradine on dyssynchrony parameters in heart failure patients. Methods: In this study, we assigned 55 patients taking medication for heart failure to receive ivabradine in addition (Group I). Twenty healthy volunteers comprised Group II. Echocardiographic measurements (dyssynchrony, left ventricular volumes and left ventricular ejection fraction) were taken at baseline, 1 month, and 3 months. Results: A total of 32 heart failure patients in Group I completed the study. There was significant improvement in dyssynchrony parameters after ivabradine treatment in Group I. Interventricular dyssynchrony (IVD) decreased from 42.0 +/- 24.4 milliseconds at baseline to 33.6 +/- 20.7 milliseconds at 1 month (P = .001) and to 30.7 +/- 19.4 milliseconds at 3 months (P < .001). Septal to posterior wall motion delay decreased from 90.3 +/- 21.4 milliseconds to 83.9 +/- 26.9 milliseconds (P = .011) at 1 month and to 81.5 +/- 27.3 milliseconds at 3 months (P = .001). Septal to lateral Ts delay (TsSL) decreased from 42.7 +/- 24.5 milliseconds to 35.8 +/- 22.6 milliseconds at 1 month (P < .001) and to 34.8 +/- 22.4 milliseconds at 3 months (P = .002). Left ventricular end-systolic volume (LVESV) decreased from 139.4 +/- 42.2 mL to 135.3 +/- 39.6 mL at 1 month (P = .006) and to 123.3 +/- 39.5 mL at 3 months (P < .001). Conclusion: The addition of ivabradine to heart failure treatment improves cardiac dyssynchrony parameters in chronic systolic heart failure patients with sinus rhythm.
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    Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study
    (LIPPINCOTT WILLIAMS & WILKINS, 2016) Basaran, Ozcan; Dogan, Volkan; Beton, Osman; Tekinalp, Mehmet; Aykan, Ahmet Cagri; Kalaycioglu, Ezgi; Bolat, Ismail; Tasar, Onur; Safak, Ozgen; Kalcik, Macit; Yaman, Mehmet; Inci, Sinan; Altintas, Bernas; Kalkan, Sedat; Kirma, Cevat; Biteker, Murat; Karadeniz, Fatma Ozpamuk; Tekkesin, Ahmet Ilker; Cakilli, Yasin; Turkkan, Ceyhan; Hamidi, Mehmet; Demir, Vahit; Gursoy, Mustafa Ozan; Ozturk, Mujgan Tek; Aksan, Gokhan; Seyis, Sabri; Balli, Mehmet; Alici, Mehmet Hayri; Bozyel, Serdar; Altun, Ibrahim; Calik, Feyza; Karaca, Oguz; Helvaci, Fusun; Akay, Kadriye; Canga, Yigit; Celebi, Savas; Altuntas, Emine; Ayturk, Mehmet; Gunes, Haci Murat; Bezgin, Tahir; Aksakal, Aytekin; Cakal, Beytullah; Colak, Ayse; Kaplan, Ozgur; Tatlisu, Adem; Gozubuyuk, Gokhan; Demirelli, Selami; Kaya, Adnan; Rencuzogullari, Ibrahim; Bayram, Zubeyde; Simsek, Zeki; Civan, Murat; Batgharel, Ulaankhu; Ata, Ali Ekber; Gol, Gokhan; Mert, Gurbet Ozge; Mert, Kadir Ugur; Degirmencioglu, Aleks; Candan, Ozkan; Celebi, Ozlem Ozcan; Dogan, Cem; Yavuz, Fethi; Ulucan, Seref; Arisoy, Arif; Sahin, Bingul Dilekci; Ermis, Emrah; Gokaslan, Serkan; Pektas, Idris; Tanindi, Asli; Tekin, Kamuran; Sancar, Kadriye Memic; Cekic, Edip Guvenc; Basaran, Nesrin Filiz
    This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients.