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    Evaluation of bleeding rate and time in therapeutic range in patients using warfarin before and during the COVID-19 pandemic-warfarin treatment in COVID-19
    (Sage Publications Inc, 2021) Emren, Zeynep Yapan; Şenöz, Oktay; Ersecgin, Ahmet; Emren, Sadık Volkan
    The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 +/- 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 +/- 21 vs 68 +/- 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.
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    Platelet-Lymphocyte ratio is a predictor for the development of no-reflow phenomenon in patients with ST-segment elevation myocardial infarction after thrombus aspiration
    (Wiley, 2021) Şenöz, Oktay; Emren, Sadık Volkan; Ersecgin, Ahmet; Yapan Emren, Zeynep; Gül, İlker
    Backround We aimed to evaluate the utility of the preprocedural platelet-lymphocyte ratio (PLR) for predicting the no-reflow phenomenon after thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Method We retrospectively analyzed postprocedural thrombolysis in myocardial infarction (TIMI) flow grades and myocardial blush grades (MBG) of 247 patients who underwent a PCI procedure with thrombus aspiration.We divided these patients into two groups according to whether they had no-reflow (TIMI < 3, MBG < 2) or not (TIMI 3, MBG >= 2). Results No-reflow developed in 43 (17%) patients.Preprocedural PLR was significantly higher in the no-reflow group (183.76 +/- 56.65 vs 118.32 +/- 50.42 p < 0.001).Independent predictors of no-reflow were as follows: higher preprocedural platelet-lymphocyte ratio (PLR) (OR = 1.018; 95% CI = 1.004, 1.033; p = 0.013),mean corpuscular volume (MCV) (OR = 1.118; 95% CI = 1.024, 1.220; p = 0.012) and SYNTAX Score-2 (OR = 1.073; 95% CI = 1.005, 1.146; p = 0.036). PLR of 144 had 79% sensitivity and 75% specificity for the prediction of no-reflow. Conclusion PLR is a reliable predictor for no-reflow in STEMI patients undergoing thrombus aspiration.
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    Systemic immune-inflammation index as a tool for predicting the need for a permanent pacemaker in patients with drug-induced atrioventricular block
    (Wiley, 2021) Şenöz, Oktay; Ersecgin, Ahmet
    Background Drug-induced atrioventricular block (AVB) is generally considered reversible and does not require a permanent pacemaker implantation (PPM). However, some studies have demonstrated a failure of AVB cessation even when the inducing agent has been discontinued. This study has investigated the use of systemic immune-inflammation index (SII) to predict irreversible drug-induced AVB after drug discontinuation. Method Files of patients with high-degree AVB that required a temporary pacemaker (TPM) were retrospectively analyzed. Sixty-three patients in which AVB was drug-induced were included in the study. The patients were divided into the following two groups: (1) those whose AVB reversed after discontinuation of the related drug, and (2) those in which AVB did not reverse. Results AVB reversed in 24 patients (38%) after the inducing agent was discontinued while in the remaining 39 patients (62%) PPM was required. The most common drugs to induce AVB were beta-blockers (n = 46, 73%). Follow-up time with TPM was significantly longer in the irreversible group (2.91 +/- 1.05 days vs. 4.94 +/- 2.15 days, p < .001). Multivariate logistic regression analysis showed that SII (odds ratio [OR] = 1.002; 95% confidence interval [CI] = 1.000-1.003; p = .01) was an independent predictor of the requirement for a PPM. An SII > 752.05 was found to be a predictor of irreversible AVB requiring PPM with a sensitivity of 64% and specificity of 75% (receiving-operating characteristics [ROC] area under the ROC curve [AUC]: 0.704, 95% CI = 0.570-0.838, p = .007). Conclusion Approximately 2/3 of drug-induced high-degree AVBs are irreversible. SII is an easily available and cheap inflammatory biomarker that can be used to predict irreversible AVB.