Tatalaksana Komplikasi Tromboemboli pada Pasien Terkonfirmasi Corona Virus Disease-19

*Alfian Aditia  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Lambung Mangkurat/RSUD Ulin; Banjarmasin, Indonesia
Mahendratama Purnama Adhi  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Lambung Mangkurat/RSUD Ulin; Banjarmasin, Indonesia
Bagus Fajar Rohman  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Lambung Mangkurat/RSUD Ulin; Banjarmasin, Indonesia
Oky Susianto scopus  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Lambung Mangkurat/RSUD Ulin; Banjarmasin, Indonesia
Erna Kusumawardhani  -  Departemen Pulmonologi dan Kedokteran Respirasi; Fakultas Kedokteran; Universitas Lambung Mangkurat/ RSUD Ulin; Banjarmasin, Indonesia
Published: 1 Nov 2020.
DOI: https://doi.org/10.14710/jai.v12i3.32906 View
Lampiran data laporan kasus tatalaksana thromboemboli pada Pasien COVID-19 terkonfirmasi
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Abstract

Latar Belakang: Corona Virus Disease-19 (COVID-19) merupakan penyakit pandemi yang dapat menyebabkan komplikasi tromboemboli sebagai akibat terjadinya koagulopati dengan insidensi sekitar 16.5-21%.  Salah satu patofisiologi koagulopati pada pasien COVID-19 disebabkan oleh proses inflamasi. Peningkatan faktor inflamasi, faktor koagulasi, dan skoring klinis digunakan sebagai prediksi terjadinya komplikasi tromboemboli. Pemberian antikoagulan memiliki peran untuk mencegah terjadinya komplikasi tersebut.

Kasus: Pasien laki-laki, 43 tahun, positif COVID-19 dengan skor PADUA = 4, peningkatan D-dimer dan mendapatkan terapi profilaksis antikoagulan. Dalam perawatan hari ke-14, sesak napas memberat, takikardi dan hipoksemia dialami pasien. Didapatkan gambaran Humpton’s hump pada foto toraks dan gambaran elektrokardiography (EKG) pola S1Q3T3 dan corrected QT interval (QTc) 552 mms. Penatalaksanaan pasien dengan ventilasi mekanik dan terapi unfractionated heparin (UFH) dosis terapeutik. Saat pasien bebas dari sedasi, ditemukan kelemahan tubuh bagian kiri.

Diskusi: Gejala klinis emboli paru umumnya berupa dispnea/takipnea, takikardi, sianosis, hemoptisis, hipoksemia dengan onset akut. Berdasarkan keparahannya, dibagi menjadi masif, sub-masif, risiko rendah. Gambaran Humpton’s hump pada foto toraks dapat menjadi dugaan terjadi emboli paru. Pemeriksaan computed tomography pulmonary angiogram (CTPA) merupakan standar diagnosisnya, namun EKG dapat digunakan sebagai modalitas kecurigaan emboli dengan gambaran takikardi/takiaritmia, pola S1Q3T3 dan pemanjangan interval QTc. Pemberian antikoagulan sebagai tromboprofilaksis tetap tidak dapat mencegah terjadinya komplikasi tromboemboli seperti terjadinya stroke iskemik, tetapi emboli paru merupakan komplikasi tromboemboli yang paling sering terjadi.

Kesimpulan: Evaluasi klinis, EKG secara rutin dan kadar D-dimer dapat menjadi pertimbangan dalam pemberian tromboprofilaksis dan dapat menjadi strategi penapisan awal risiko komplikasi tromboemboli. Pada pasien COVID-19 derajat kritis perlu dipertimbangkan pemberian antikoagulan yang lebih agresif dan menggunakan dosis terapeutik.

Note: This article has supplementary file(s).

Keywords: COVID-19; emboli paru; stroke; thromboprofilaksis; tromboemboli

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