Association of neutrophil/lymphocyte ratio with plaque morphology in patients with asymptomatic intermediate carotid artery stenosis

WOS: 000384706100016PubMed ID: 27721862Background and Objectives: Non-calcified carotid plaques are more unstable than calcified plaques; and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke. The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis with respect to neutrophil/lymphocyte ratio (NLR). Subjects and Methods: A total number of 139 asymptomatic patients with 50-70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n=73)and non-calcified (n=66) plaque groups were compared with respect to total neutrophil count, lymphocyte count and NLR. Results: Total lymphocyte count was statistically significantly lower in the non-calcified plaque group compared to the calcified plaque group (total lymphocyte count in non-calcified/calcified plaque groups [10(3)/mm(3)]: 2.1/2.3, respectively) (p=0.002). NLR was statistically significantly higher in the non-calcified plaque group compared to the calcified plaque group (NLR in non-calcified/calcified plaque groups: 2.6/2.1, respectively) (p2.54. Multivariate regression analysis showed that NLR was independently associated with non-calcified carotid artery plaques (odds ratio 5.686, 95% CI 2.498-12.944, p<0.001). Conclusions: NLR is increased in the presence of non-calcified carotid artery plaques that cause asymptomatic intermediate stenosis. Increased NLR can be used as a marker to assess the risk of rupture of non-calcified carotid artery plaques

Predictors of symptom development in intermediate carotid artery stenosis: Mean platelet volume and platelet distribution width

Platelets play an important role in the pathogenesis of atherothrombosis. Platelet activation is associated with increased mean platelet volume (MPV) and platelet distribution width (PDW). In this study, we investigated the relation of MPV and PDW with the risk of stroke in patients with intermediate (50%-70%) carotid artery stenosis. A total of 254 patients (115 symptomatic and 139 asymptomatic) with intermediate carotid artery stenosis were enrolled in this study. Symptomatic and asymptomatic patients were compared in regard to MPV and PDW. Mean platelet volume was significantly greater in the symptomatic group compared with the asymptomatic group (11.1 and 9.4 fL, respectively; P < .001). Platelet distribution width was significantly greater in the symptomatic group compared with the asymptomatic group (15.0% and 11.9%, respectively; P < .001). Multivariate regression analysis showed that an MPV 10.2 fL and a PDW 14.3% were independent predictors of developing symptomatic carotid artery stenosis. Mean platelet volume and PDW are increased in the presence of symptomatic intermediate carotid artery stenosis. Increased MPV and PDW may be independent predictors of developing symptomatic carotid artery plaque

Assessment of NOAC dosing patterns in Turkish patients with non-valvular atrial fibrillation: A multicenter, cross-sectional study with insights from the ASPECT-NOAC study

AbstractAim: We aimed to assess the real‐world label adherence of non‐vitamin K antagonist oralanticoagulant (NOAC) dosing patterns, including apixaban, edoxaban, and rivaroxaban, as wellas their clinical outcomes in Turkish patients with atrial fibrillation (AF).Methods: This was an observational, prospective, multicenter study. Patients with AF who wereprescribed NOACs within the last 4 months were recruited from 34 cardiology clinics in Turkey.Baseline data were initially collected, and patient awareness was evaluated at 3–4 weeks. Thefinal study visit was conducted at 12 months.Results: A total of 903 patients were enrolled in the study. The mean age was 72.84 ± 10.17years, and 475 patients (52.6%) were female. We found that 140 (15.5%), 721 (79.8%), and 42patients (4.7%) were prescribed off-label low, on-label, and off-label high dosing, respectively.The age of the patients in the on-label group was significantly lower than that of those in the off-label low and off-label high groups (both p&amp;lt;0.001). Additionally, female patients were morefrequently observed in the off-label high group (p=0.019), and patients in the off-label low andon-label groups were significantly more obese than those in the low-label group (p&amp;lt;0.001). Theperception of income levels also revealed significant differences between the groups (p=0.010).Furthermore, the HAS-BLED scores were significantly lower in the on-label group than in theother groups (both p&amp;lt;0.001). Similarly, the CHA 2 DS 2 -VASc scores were significantly lower inthe on-label group than in the off-label group (p&amp;lt;0.001).Conclusion: Off-label low-dose NOAC prescriptions were relatively common in Turkishpatients; however, this was much lower than in previously reported results. Increasing clinicianawareness of appropriate NOAC dosing may help identify at-risk patients.Keywords: atrial fibrillation, anticoagulants, NOACs, dosing pattern, patient medicationknowledge</p