An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

Effects of using a different kind of smokeless tobacco on cardiac parameters: "Maras Powder".

OBJECTIVE: A plant powder called "Maras Powder" has been used widely instead of cigarette in the South-Eastern region of Turkey. It was confirmed that this powder has been made of tobacco N. rustica L. Our aim was to investigate whether the use of Maras Powder is as harmful as cigarette smoking or not. METHODS: Forty-five Maras Powder users (Group I), 32 persons who smoked cigarette (control-Group II) and 30 healthy persons neither smoking nor using Maras Powder (Group III) were included into the study. Laboratory investigations, electrocardiography and echocardiography were performed in all participants of the study. For evaluation of the ventricular repolarization parameters, 50 mm/sec ECG recordings were used. Echocardiographic investigation was performed for assessment systolic and diastolic function. RESULTS: No differences were found by means of ventricular repolarization parameters among the three groups (p>0.05). Echocardiographic investigation revealed similar systolic function results in all of the three groups. There was reduced early filling velocity of the left ventricle (p=0.03, p=0.02) and increased filling velocity of the atrial component (p=0.02, p=0.02) in group I and group II. When they were compared to group III, deceleration time was also increased (p<0.01, p<0.01). Isovolumetric relaxation time was higher in group I and group II than that of group III (p=0.02, p=0.03). In group I and group II, total cholesterol (p=0.03, p=0.02), LDL-cholesterol (p<0.01, p<0.01) and triglyceride levels (p<0.01, p<0.01) were found to be higher than those of group III, whereas HDL levels were lower (p=0.02, p<0.01). CONCLUSION: As a result, we thought that Maras Powder is as harmful as cigarette smoking and it has similar negative effects on cardiovascular system. In our opinion, "Maras Powder" is a smokeless tobacco use.