DOI: https://doi.org/10.14710/jai.v12i3.32906

Tatalaksana Komplikasi Tromboemboli pada Pasien Terkonfirmasi Corona Virus Disease-19

1Departemen Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Lambung Mangkurat/RSUD Ulin, Banjarmasin, Indonesia

2Departemen Pulmonologi dan Kedokteran Respirasi, Fakultas Kedokteran, Universitas Lambung Mangkurat/RSUD Ulin, Banjarmasin, Indonesia

Published: 1 Nov 2020.
Open Access Copyright 2020 JAI (Jurnal Anestesiologi Indonesia)

Citation Format:
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).

Fulltext View|Download |  Source Text
Lampiran data laporan kasus tatalaksana thromboemboli pada Pasien COVID-19 terkonfirmasi
Subject
Type Source Text
  Download (2MB)    Indexing metadata
Keywords: COVID-19; emboli paru; stroke; thromboprofilaksis; tromboemboli

Article Metrics:

Article Info
Section: Case Reports
Language : ID
Recent articles
Potensi Pemberian Tocilizumab pada Pasien COVID-19 Di ICU RSUD Ulin Banjarmasin Ko-infeksi Jamur pada COVID-19 dengan Terapi Steroid Tatalaksana Komplikasi Tromboemboli pada Pasien Terkonfirmasi Corona Virus Disease-19 More recent articles
Most cited articles
Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida Patofisiologi Penyakit Jantung Koroner More cited articles
  1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-160. doi: 10.23750/abm.v91i1.9397
  2. Lodigiani C, Iapichino G, Carenzo L, et al. Jo ur l P of. Thromb Res. Published online 2020. doi: 10.1016/j.thromres.2020.04.024
  3. Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS ‑ CoV ‑ 2 infection : a multicenter prospective cohort study. Intensive Care Med. Published online 2020. doi: 10.1007/s00134-020-06062-x
  4. Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol. 2020;189(5):846-847. doi: 10.1111/bjh.16727
  5. Greenberg CS. Advances in hematology. 2017;15(8):580-583
  6. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi: 10.1056/NEJMoa2002032
  7. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan , China : a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3
  8. Moore MP. d-Dimer testing for the exclusion of venous thromboembolism in pregnancy. Intern Med J. 2018;48(8):1013. doi: 10.1111/imj.13978
  9. Zhai Z, Li C, Chen Y, et al. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937-948. doi: 10.1055/s-0040-1710019
  10. Moores LK, Tritschler T, Brosnahan S, et al. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019. Chest. 2020;(June). doi: 10.1016/j.chest.2020.05.559
  11. Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020;18(7):1743-1746. doi: 10.1111/jth.14869
  12. Klok FA, Kruip MJHA, Meer NJM Van Der, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191(April):145-147. doi: 10.1016/j.thromres.2020.04.013
  13. Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-115. doi: 10.1016/j.thromres.2020.06.029
  14. Hajra A, Mathai SV, Ball S, et al. Management of Thrombotic Complications in COVID-19: An Update. Drugs. 2020;(0123456789). doi: 10.1007/s40265-020-01377-x
  15. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol. 2020;20(June):355-362. doi: 10.1038/s41577-020-0331-4
  16. Perera A, Chowdary P, Johnson J, Lamb L, Drebes A, Mir N, Sood T. Elevated D-dimers Useful Prediction of Pulmonary Artery Thrombosis in COVID-19 Patients at Initial Presentation to Hospital [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https:// 2020. No Title
  17. Hilal Dagkiran, Riza Atas, Ivana Tomic, Claudia Plachtzik, MD, Tobias Geisler, MD, Meinrad P Gawaz, MD, Martin Oberhoff, MD, Thomas Anger M. Severe Pulmonary Embolism with Negative D-Dimer-Testing. J Cardiol Ther. 2015;2(1):265-268. doi: 10.6051/j.issn.2309-6861.2015.02.66
  18. Yu B, Li X, Chen J, et al. Evaluation of variation in D ‑ dimer levels among COVID ‑ 19 and bacterial pneumonia : a retrospective analysis. J Thromb Thrombolysis. 2020;2(December 2019). doi: 10.1007/s11239-020-02171-y
  19. Marshall PS, Mathews KS, Siegel MD. Diagnosis and management of life-threatening pulmonary embolism. J Intensive Care Med. 2011;26(5):275-294. doi: 10.1177/0885066610392658
  20. Shawn TH, Yan L, Lateef F. The chest X ray in pulmonary embolism: Westermark sign, Hampton’s Hump and Palla’s sign. What’s the difference? J Acute Dis. 2018;7(3):99. doi: 10.4103/2221-6189.236822
  21. Konstantinides S V., Meyer G, Bueno H, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41(4):543-603. doi: 10.1093/eurheartj/ehz405
  22. Nadrous HF, Olson EJ, Douglas WW, Decker PA, Nadrous JH. Cryptic Septic Shock : A Sub-analysis of Early , Goal-Directed Therapy. Chest. 2014;124(October 2003):1090850. doi: 10.1378/chest.124.4
  23. Matsushita K, Marchandot B, Jesel L, Ohlmann P, Morel O. Impact of COVID-19 on the Cardiovascular System: A Review. J Clin Med. 2020;9(5):1407. doi: 10.3390/jcm9051407
  24. Buppajarntham S, Seetha Rammohan HR, Junpaparp P, Figueredo VM. Prognostic value of prolonged QTc interval in patients with acute pulmonary embolism. Acta Cardiol. 2014;69(5):550-555. doi: 10.1080/ac.69.5.3044882
  25. Reddy ST, Garg T, Shah C, et al. Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series. Case Rep Neurol. 2020;77030:199-209. doi: 10.1159/000508958
  26. Busse LW, Vourlekis JS. Submassive pulmonary embolism. Crit Care Clin. 2014;30(3):447-473. doi: 10.1016/j.ccc.2014.03.006
  27. Wang J, Hajizadeh N, Moore EE, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost. 2020;18(7):1752-1755. doi: 10.1111/jth.14828

Last update:

  1. D-DIMER AS A PROGNOSIS OF THE SEVERITY OF COVID-19 PATIENTS AT BEKASI REGENCY HOSPITAL

    Dyah Eka Kurniawati. Jurnal Biosains Pascasarjana, 26 (1), 2024. doi: 10.20473/jbp.v26i1.2024.28-37

Last update: 2024-12-21 11:10:38

No citation recorded.