Perbedaan Pengaruh Parasetamol dan Parecoxib Terhadap Aktivitas Agregasi Trombosit pada Pasien SIRS atau Sepsis

*Admaji Wibowo -  Bagian Anestesi dan Terapi Intensif, Fakultas Kedokteran, Universitas Sebelas Maret Surakarta, Indonesia
Purwoko Purwoko -  Bagian Anestesi dan Terapi Intensif, Fakultas Kedokteran, Universitas Sebelas Maret Surakarta, Indonesia
Suradi Suradi -  Bagian Pulmonologi, Fakultas Kedokteran, Universitas Sebelas Maret Surakarta, Indonesia
Published: 1 Nov 2018.
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Section: Penelitian
Language: ID
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Statistics: 104 53
Abstract

Latar Belakang: Parasetamol dan parecoxib adalah Obat Anti Inflamasi Non Steroid (OAINS) yang paling banyak digunakan pada pasien yang dirawat dengan SIRS atau sepsis di ICU sebagai antipiretik dan anti inflamasi. Kedua obat tersebut dapat mempengaruhi agregasi trombosit yang dapat kita nilai melalui tes agregasi trombosit.

Tujuan: Mengetahui perbedaan pengaruh pemberian parasetamol dan parecoxib terhadap aktivitas agregasi trombosit pada pasien SIRS atau sepsis.

Metode: Penelitian ini merupakan penelitian experimental dengan pendekatan uji klinis dengan rancangan penelitian pre dan post. Terdapat 34 subjek penelitian pasien SIRS atau sepsis yang dirawat di ICU dengan umur antara 17 - 65 tahun. Distribusi sampel meliputi 17 subjek dengan pemberian parasetamol dan 17 subjek dengan pemberian parecoxib. Setelah dilakukan pengacakan dilakukan pemeriksaan agregasi trombosit sebelum perlakuan dan 120 menit sesudah perlakuan dengan menggunakan induktor 10 µM ADP.

Hasil: Berdasarkan hasil uji beda Mann Whitney pada kelompok tidak berpasangan mendapatkan nilai p=0,310, yang berarti bahwa tidak ada perbedaan yang signifikan dalam hal agregasi trombosit antara kelompok parasetamol dan parecoxib sebelum perlakuan dan nilai p=0,013 (p<0,05), yang berarti bahwa terdapat perbedaan yang signifikan antara kelompok parasetamol dan parecoxib setelah perlakuan. Analisa selanjutnya berdasarkan hasil uji beda Wilcoxon pada kelompok berpasangan mendapat nilai p=0,020 (p<0,05) yang berarti bahwa terdapat perbedaan yang signifikan antara sebelum dan sesudah pemberian parasetamol.

Kesimpulan: Penggunaan parasetamol akan berdampak pada penurunan agregasi trombosit secara signifikan secara statistik dibandingkan dengan parecoxib (p=0,013).

Note: This article has supplementary file(s).

Keywords
agregasi trombosit; parasetamol; parecoxib; OAINS; sepsis

Article Metrics:

  1. Dhillon A, Bittner E. Nonantibiotic therapies for sepsis. Dalam : Critical care handbook of the massachusetts general hospital. 5th ed. Philadelphia: Lippincot Williams & Wilkins; 2010. hal 447
  2. Martin GS, Mannino DM, Eaton S, Moss M.The epidemiology of sepsis in the United States from 1979 through 2000. EnglJ Med.2003; 348: 1546-1554
  3. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the united states: analysis of incidence, outcome, and associated costs of care. Critc Care Med. 2001; 29: 1303-10
  4. Leksana E. Systemic Inflammatory Response Syndrome. Cermin Dunia Kedokteran. 2013;40 (1): 7–11
  5. Rello J, Diaz, E, Rodriquez A. Management of sepsis: The PIRO Approach. Berlin : Springer- Verlag; 2009. hal 147
  6. Munford, RS. Severe sepsis and septic shock. Dalam : Harison’s Principles of internal medicine. 18th ed. New York: McGraw-Hill; 2011: 502-07
  7. Hamilton SM, Bayer CR, Stevens DL, Bryant, AE. Effects of selective and nonselective nonsteroidal anti-inflammatory drugs on antibiotic efficacy of experimental group a streptocomlal myonecrosis. J of Infection Disease. 2014; 209: 1429–35
  8. Kara E, Var A, Vatansever S, Cilaker S, Kaya Y,Cokun Y. Effects of rofecoxib, a selective cyclooxygenase-2 inhibitor on endothelial dysfunction, lipid peroxidation and hepatocyte morphology in rats with sepsis-induced liver damage. Cur Thera research. 2004; 65 (3): 278-91
  9. Chong SJ, Wong YC, Wu J, Tan MH, Lu J, Moochhala SM. Parecoxib reduces systemic inflammation and acute lung injury in burned animals with delayed fluid resuscitation. Intl J 1. of Inflam. 2014; 73 (6): 1-11
  10. Greenberg RS, Chen H, Hasday JD. Acetaminophen has limited antipyretic activity in critically ill patients. J Crit Care. 2010; 25 (2):1-13
  11. Selladurai S, Eastwood GM, Bailey M, Bellomo R. Paracetamol therapy for septic critically ill patients: a retrospective observational study. Critical Care Resuscitation. 2011; 13: 181–6
  12. Lee BH, InuiD, Suh GY,Kim JY, Kwon JY, Park J,Tada K et al. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. CritCare, 2012;16:1-13
  13. Janz DR, Bastarache JA, Rice TW,Bernard GR, Warren MA, Wickersham N et al.Randomized, placebo-controlled trial of acetaminophen for the reduction of oxidative injury in severe sepsis: the ACROSS trial. Crit Care Med. 2015; 43 (3): 534-41
  14. Husain AA dan Martin GS. What's old is new again: acetaminophen as a novel approach to treating sepsis. CritCare Med. 2015; 43 (3): 698-99
  15. Ferdinand J, Brahmi NH, Sasongko H. Pengaruh pemberian ketorolak dan parecoxib intramuskuler terhadap gambaran histopatologi tubulus proksimal ginjal tikus wistar. Jurnal Anestesi Indonesia. 2014; 8 (2): 125-37
  16. Munsterhjelm E. Characterization of Inhibition of Platelet Function by Paracetamol and its Interaction with Diclofenac and Parecoxib. [Disertasi] Helsinki; Universitas Helsinki; 2006: 1-53
  17. Mattia C, Coluzzi F. What anesthesiologists should know about paracetamol (acetaminophen). Minerva Anest. 2009; 75: 644-53
  18. Viscusi ER., Singla N, Gonzalez A, Saad N, Stepanian J. Intravenous acetaminophen improves pain management and reduces opioid requirements in surgical patients. A review of the clinical data and case-based presentations. 2012:1-8
  19. Rosenquist RW dan Vrooman BM.. Chronic pain management. Dalam: Morgan dan mikhail’s clinical anesthesiology. 5th ed. New York: McGraw-Hill; 2013: 1023-85
  20. Leese PT, Recker DP, Kent JD. The COX-2 selective inhibitor, valdecoxib, does not impair platelet function in the elderly: results of a randomized controlled trial. The J of Clin Pharm. 2003; 43 (5): 504–13
  21. Baley K, Michalov K, Kossick MA, McDowell M. Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review. American Assoc of Nurse Anesth J.2014; 82 (1): 53-64
  22. Munsterhjelm E, Niemi TT, YlikorkalaO, Neuvonen PJ, Rosenberg PH. Influence on platelet aggregation of i.v. parecoxib and acetaminophen in 1. healthy volunteers. Brit J of Anaesth. 2006; 2: 226–31
  23. Timothy DW, Jane AM. Cyclooxygenase-3 (COX-3): filling in the gaps toward a COX continum. Proceedings of the Nat Academy of Sci. 2001; 99 (21): 133-41
  24. Noveck RJ, Laurent A, Kuss M, Talwalker S, Hubbard RC. Parecoxib sodium does not impair platelet fuction in healthy elderly and non-elderly individuals. Clin Drug Invest. 2001; 21 (7): 465-76
  25. Ferrari, R. A, Ward, S. J., Zobre, C. M., Van Liew, D. K., Perrone, M. H., Connell, M. J. and Haubrich, D. R. (1990). Estimation of the in vivo effect of cyclooxygenase inhibitors on prostaglandin E2 levels in mouse brain, Eur. J. Pharmacol. 179, 25–34.