{"id":6435,"date":"2024-12-31T08:43:53","date_gmt":"2024-12-31T05:43:53","guid":{"rendered":"https:\/\/www.klimik.org.tr\/koronavirus\/?p=6435"},"modified":"2025-01-16T08:46:03","modified_gmt":"2025-01-16T05:46:03","slug":"covid-19-asilari-kalp-krizine-ve-felc-gelismesine-neden-olur-mu","status":"publish","type":"post","link":"https:\/\/www.klimik.org.tr\/koronavirus\/covid-19-asilari-kalp-krizine-ve-felc-gelismesine-neden-olur-mu\/","title":{"rendered":"COVID-19 A\u015f\u0131lar\u0131 Kalp Krizine ve Fel\u00e7 Geli\u015fmesine Neden Olur mu?"},"content":{"rendered":"

\"\"Toplumu yanl\u0131\u015f bilgilendirmekten \u00e7ekinmeyen hatta bundan farkl\u0131 \u015fekillerde kazan\u00e7 (\u00fcn, para, \u00e7\u0131kar vb.) elde etti\u011fi i\u00e7in bile isteye yapan malum televizyon fig\u00fcrleri nedeniyle insanlar\u0131m\u0131z\u0131n kafas\u0131nda a\u015f\u0131lara kar\u015f\u0131 yine b\u00fcy\u00fck soru i\u015faretleri olu\u015fmu\u015f durumda. Endi\u015fe i\u00e7inde, \u201cCOVID-19 a\u015f\u0131lar\u0131n\u0131n sebep olaca\u011f\u0131\u201d kalp krizi ve fel\u00e7leri bekliyorlar!<\/strong><\/p>\n

COVID-19 pandemisinin bitmesi, ba\u015fka bir ifadeyle hastal\u0131\u011f\u0131n art\u0131k insanlarda g\u00f6rmeyi bekledi\u011fimiz solunum yolu infeksiyonlar\u0131ndan biri haline gelmesi ve \u00f6zellikle belli risk gruplar\u0131 d\u0131\u015f\u0131nda \u00f6ld\u00fcr\u00fcc\u00fcl\u00fc\u011f\u00fcn\u00fc kaybetmesiyle birlikte insanlarda risk alg\u0131s\u0131n\u0131n azald\u0131\u011f\u0131 bir d\u00f6nemi ya\u015f\u0131yoruz. Her infeksiyon hastal\u0131\u011f\u0131nda oldu\u011fu gibi hastal\u0131kla ilgili risklerin azalmas\u0131 a\u015f\u0131lar ve tedavi ajanlar\u0131n\u0131n ne kadar gerekli oldu\u011fu sorusunu da beraberinde getiriyor. A\u015f\u0131lar bulunmadan \u00f6nce, delta varyant\u0131 d\u00fcnyay\u0131 kas\u0131p kavururken her g\u00fcn binlerce insan \u00f6l\u00fcrken a\u015f\u0131lar\u0131 hi\u00e7 sorgulamadan yapt\u0131ran insanlar \u015fimdi \u201cBiz niye olduk o a\u015f\u0131lar\u0131?\u201d diye sorgular hale geldiler. Bu da bekledi\u011fimiz bir \u015feydi asl\u0131nda. Bu soruyu soranlara Hindistan\u2019da, \u0130talya\u2019da yatacak yatak ve oksijen bulunamad\u0131\u011f\u0131 i\u00e7in hastane koridorlar\u0131nda, bah\u00e7elerinde hayat\u0131n\u0131 kaybeden insanlar\u0131 hat\u0131rlatmak, a\u015f\u0131 sayesinde milyonlarca ki\u015finin hayat\u0131n\u0131n kurtuldu\u011funu s\u00f6ylemek yeterli gelmiyor ne yaz\u0131k ki. Toplumu yanl\u0131\u015f bilgilendirmekten \u00e7ekinmeyen hatta bundan farkl\u0131 \u015fekillerde kazan\u00e7 (\u00fcn, para, \u00e7\u0131kar vb.) elde etti\u011fi i\u00e7in bile isteye yapan malum televizyon fig\u00fcrleri nedeniyle insanlar\u0131m\u0131z\u0131n kafas\u0131nda a\u015f\u0131lara kar\u015f\u0131 yine b\u00fcy\u00fck soru i\u015faretleri olu\u015fmu\u015f durumda. Endi\u015fe i\u00e7inde, \u201cCOVID-19 a\u015f\u0131lar\u0131n\u0131n sebep olaca\u011f\u0131\u201d kalp krizi ve fel\u00e7leri bekliyorlar!<\/p>\n

Peki COVID-19 a\u015f\u0131lar\u0131 kalp krizi veya fel\u00e7 geli\u015fmesine neden oluyor mu?<\/p>\n

Bilimsel yakla\u015f\u0131m, ortaya at\u0131lan herhangi bir iddian\u0131n, basit ak\u0131l y\u00fcr\u00fctme veya \u00f6nceki g\u00f6zlemlerle yanl\u0131\u015f oldu\u011fu bilim \u00e7evrelerince ba\u015ftan biliniyor olmad\u0131\u011f\u0131 s\u00fcrece, do\u011frulu\u011funu ara\u015ft\u0131rmay\u0131 gerektirir. \u00d6zellikle t\u0131p alan\u0131nda, hele a\u015f\u0131 uygulamalar\u0131nda en ufak bir iddia bile bilimsel y\u00f6ntemlerle ara\u015ft\u0131r\u0131l\u0131r. T\u0131ptaki b\u00fct\u00fcn uygulamalar i\u00e7in ge\u00e7erli olan bu kural, COVID-19 a\u015f\u0131lar\u0131 i\u00e7in de ge\u00e7erli. Sadece \u00fclkemizde de\u011fil t\u00fcm D\u00fcnya\u2019da bu a\u015f\u0131lar\u0131n ayn\u0131 etkilerine dair iddialar ortaya at\u0131l\u0131nca i\u015f yine biliminsanlar\u0131na d\u00fc\u015ft\u00fc. Bu iddialar\u0131 ara\u015ft\u0131rmak, do\u011fru veya yanl\u0131\u015f oldu\u011funu kan\u0131tlamak i\u00e7in \u00e7al\u0131\u015fmalar h\u0131zla planland\u0131. Ba\u015ftan s\u00f6yleyelim; \u00e7ok b\u00fcy\u00fck say\u0131da hasta i\u00e7eren kar\u015f\u0131la\u015ft\u0131rmal\u0131 \u00e7al\u0131\u015fmalar COVID-19 a\u015f\u0131lar\u0131n\u0131n kalp krizi veya fel\u00e7 yapmad\u0131\u011f\u0131n\u0131 tersine bunlara kar\u015f\u0131 koruma sa\u011flad\u0131\u011f\u0131n\u0131 g\u00f6sterdi.<\/p>\n

Endi\u015fe i\u00e7indeki insanlar\u0131 rahatlatabilmek i\u00e7in bu \u00e7al\u0131\u015fmalar\u0131n y\u00f6ntem ve sonu\u00e7lar\u0131n\u0131 k\u0131saca \u00f6zetlemek yerinde olacakt\u0131r.<\/p>\n

COVID-19 a\u015f\u0131lar\u0131n\u0131n kalp yetmezli\u011fi, toplardamarlarda t\u0131kan\u0131kl\u0131k (ven\u00f6z tromboemboli) ve atardamarlarda t\u0131kan\u0131kl\u0131k (arteryel tromboemboli: kalp krizi ve fel\u00e7 buna ba\u011fl\u0131 geli\u015fir) yap\u0131p yapmad\u0131\u011f\u0131n\u0131 ara\u015ft\u0131ran en b\u00fcy\u00fck \u00e7al\u0131\u015fma 2024 Ocak ay\u0131nda yay\u0131mland\u0131 (1).\u00a0\u00c7al\u0131\u015fmada \u0130ngiltere, \u0130spanya ve Estonya\u2019dan COVID-19 a\u015f\u0131s\u0131 (mRNA, viral vekt\u00f6r, protein a\u015f\u0131lar) yap\u0131lan 10 milyon 170 bin ki\u015fiyle a\u015f\u0131lanmam\u0131\u015f 10 milyon 390 bin ki\u015fi bir y\u0131l s\u00fcreyle takip edilerek kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f. \u00d6ncelikle t\u0131pta bu kadar \u00e7ok (milyonlarca) hasta ile yap\u0131lan \u00e7al\u0131\u015fmalar\u0131n \u00e7ok nadir oldu\u011funu belirtelim. \u00c7al\u0131\u015fma sonucunda a\u015f\u0131lar\u0131n 30. g\u00fcn sonunda ven\u00f6z tromboemboliyi %88, arteryel tromboemboliyi %47, kalp yetmezli\u011fini %55 azaltt\u0131\u011f\u0131, 30 g\u00fcn-180 g\u00fcn aras\u0131nda ise bu oranlar\u0131n, s\u0131ras\u0131yla; %47, %28 ve %39 oldu\u011fu g\u00f6sterilmi\u015f. Yani milyonlarca ki\u015finin uzun d\u00f6nem takibi sonucunda b\u0131rak\u0131n a\u015f\u0131lar\u0131n kalp krizine neden olmas\u0131n\u0131, tam tersine belirgin olarak azaltt\u0131klar\u0131 g\u00f6zlenmi\u015f durumda.<\/p>\n

\n

Bir di\u011fer \u00e7al\u0131\u015fma, a\u015f\u0131lar\u0131n COVID-19 hastal\u0131\u011f\u0131 sonras\u0131nda fel\u00e7 geli\u015fme riski \u00fczerine etkisini ara\u015ft\u0131rmak \u00fczere Tayvan ve ABD\u2019den ara\u015ft\u0131r\u0131c\u0131lar taraf\u0131ndan tasarlanm\u0131\u015f ve 300 binden fazla hastan\u0131n alt\u0131 ayl\u0131k takip sonu\u00e7lar\u0131n\u0131 i\u00e7eriyor (2). \u00c7al\u0131\u015fmada COVID-19 a\u015f\u0131s\u0131 yap\u0131lan 151 597 ki\u015fiye kar\u015f\u0131l\u0131k COVID-19 a\u015f\u0131s\u0131 yap\u0131lmayan ayn\u0131 say\u0131daki ki\u015fi ge\u00e7irdikleri COVID-19 infeksiyonu sonras\u0131ndaki alt\u0131 ay i\u00e7erisinde fel\u00e7 ge\u00e7irip ge\u00e7irmemeleri a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f. \u00c7al\u0131\u015fma sonucunda a\u015f\u0131lanm\u0131\u015f ki\u015filerde COVID-19\u2019dan sonraki ilk alt\u0131 ay i\u00e7erisinde fel\u00e7 olma riskinin %35 daha d\u00fc\u015f\u00fck oldu\u011fu g\u00f6sterilmi\u015f.<\/p>\n

Bu konuda \u00f6nemli veri sunan bir \u00e7al\u0131\u015fmada da a\u015f\u0131lanm\u0131\u015f olman\u0131n hastal\u0131k ge\u00e7irdikten sonra damar t\u0131kan\u0131kl\u0131\u011f\u0131yla giden komplikasyonlar (tromboembolik olaylar) geli\u015fmesi \u00fczerine etkisi 16 binden fazla ki\u015fide olgu-kontrol y\u00f6ntemi ile ara\u015ft\u0131r\u0131lm\u0131\u015f (3).\u00a0Bu \u00e7al\u0131\u015fmaya g\u00f6re a\u015f\u0131land\u0131ktan sonra COVID-19 ge\u00e7iren ki\u015filerde tromboembolik olaylar (COVID-19 ge\u00e7irmeyenlere k\u0131yasla) 2.7 kat artarken, a\u015f\u0131lanmam\u0131\u015fken COVID-19 ge\u00e7irenlerde tromboembolik olaylar (COVID-19 ge\u00e7irmeyenlere k\u0131yasla) 4,6 kat artm\u0131\u015f. Bir ba\u015fka ifade ile a\u015f\u0131lanmak COVID-19 sonras\u0131 tromboembolik olay geli\u015fme s\u0131kl\u0131\u011f\u0131n\u0131 neredeyse yar\u0131 yar\u0131ya azaltm\u0131\u015f.<\/p>\n

Elbette a\u015f\u0131lar\u0131n birtak\u0131m yan etkileri var. \u00dclkemizde hi\u00e7 uygulanmayan Az-ChadOx (viral vekt\u00f6r tipi) a\u015f\u0131s\u0131n\u0131n gen\u00e7 kad\u0131nlarda kalp krizini de\u011fil belki ama ven\u00f6z tromboemboli s\u0131kl\u0131\u011f\u0131n\u0131 art\u0131rd\u0131\u011f\u0131n\u0131 biliyoruz. Buna ra\u011fmen ba\u015fka a\u015f\u0131ya ula\u015famayan (COVID-19 i\u00e7in geli\u015ftirilen en ucuz a\u015f\u0131 Az-ChadOx a\u015f\u0131s\u0131yd\u0131) \u00e7ok say\u0131da \u00fclke, bu a\u015f\u0131y\u0131 uygulamaya devam etti. \u00c7\u00fcnk\u00fc bu hafif artm\u0131\u015f riske ra\u011fmen COVID-19 hastal\u0131\u011f\u0131n\u0131n kendisinin neden oldu\u011fu komplikasyonlar\u0131 belirgin olarak azaltmaktayd\u0131. Faydas\u0131 olas\u0131 zarar\u0131ndan belirgin olarak \u00f6ndeydi. T\u0131pta her uygulaman\u0131n, basit bir ila\u00e7 tedavisinin bile bir riski vard\u0131r. \u00d6nemli olan o riski g\u00f6ze alarak elde edece\u011fimiz faydan\u0131n ne kadar y\u00fcksek oldu\u011fudur, yani fayda\/zarar oran\u0131d\u0131r. Art\u0131k COVID-19\u2019un v\u00fccutta sistemik inflamasyonu tetikleyerek damarlar\u0131n i\u00e7 y\u00fczeyini d\u00f6\u015feyen endotel h\u00fccrelerine zarar verdi\u011fini, bunun sonucunda hem atardamar hem de toplardamarlarda p\u0131ht\u0131la\u015fma, emboli ve t\u0131kanma gibi ciddi sonu\u00e7lara yol a\u00e7t\u0131\u011f\u0131n\u0131 \u00e7ok iyi biliyoruz. A\u015f\u0131lar COVID-19\u2019u engelleyerek veya hafif ge\u00e7irilmesini (b\u00f6ylelikle sistemik inflamasyonun \u00e7ok az ger\u00e7ekle\u015fmesini) sa\u011flayarak bu ciddi sonu\u00e7lar\u0131 azalt\u0131yor. \u00dcstelik yeni \u00e7al\u0131\u015fmalar COVID-19 infeksiyonundan aylar sonra bile kanda p\u0131ht\u0131la\u015fmaya yatk\u0131nl\u0131\u011f\u0131n devam etti\u011fini g\u00f6steriyor. Benzer bir mekanizma grip ve zat\u00fcrre hastal\u0131klar\u0131nda da s\u00f6z konusu oldu\u011fu i\u00e7in grip a\u015f\u0131lar\u0131 ve zat\u00fcrre a\u015f\u0131s\u0131 da kalp krizi ve fel\u00e7 riskini azaltmaktad\u0131r. Hatta bu y\u00fczden \u201ckalp krizine kar\u015f\u0131 a\u015f\u0131lar\u201d olarak telaffuz edilmektedir. H\u00e2l\u00e2 COVID-19 hakk\u0131nda \u00f6\u011frenece\u011fimiz \u015feyler var gibi g\u00f6r\u00fcn\u00fcyor. Ama bilim \u00e7evrelerinin emin oldu\u011fu tek \u015fey, a\u015f\u0131lar\u0131n kalp krizi, fel\u00e7, uzam\u0131\u015f COVID dahil olmak \u00fczere pek \u00e7ok ciddi komplikasyonu belirgin olarak azaltt\u0131\u011f\u0131d\u0131r. Rehberimiz bilimse, bilimsel veriler bu y\u00f6nde.<\/p>\n

Prof. Dr. Alpay AZAP
\nT\u00fcrk Tabipleri Birli\u011fi Merkez Konseyi Ba\u015fkan\u0131<\/strong><\/p>\n

Yaz\u0131 \u0130\u00e7in T\u0131klay\u0131n\u0131z<\/strong><\/a><\/p>\n

KAYNAKLAR<\/strong><\/p>\n

1) Mercad\u00e9-Besora N, Li X, Kolde R, et al<\/em>. The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications. Heart<\/em>. 2024; 110 (9): 635-43.<\/p>\n

2) Chen SY, Hsieh TYJ, Hung YM, et al<\/em>. Prior COVID-19 vaccination and reduced risk of cerebrovascular diseases among COVID-19 survivors. J Med Virol<\/em>. 2024; 96 (5): e29648.<\/p>\n

3) ran HNQ, Risk M, Nair GB, Zhao L. Risk benefit analysis to evaluate risk of thromboembolic events after mRNA COVID-19 vaccination and COVID-19. NPJ Vaccines<\/em>. 2024; 9 (1):166.<\/p>\n<\/div>\n