Pengaruh Profilaksis Trombosis Vena Dalam dengan Heparin Subkutan dan Intravena terhadap aPTT dan Jumlah Trombosit pada Pasien Kritis di ICU RSUP Dr. Kariadi Semarang

*Satrio Adi Wicaksono -  Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro/ RSUP Dr. Kariadi Semarang, Indonesia
Jati Listiyanto Pujo -  Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro/ RSUP Dr. Kariadi Semarang, Indonesia
Ery Leksana -  Bagian Anestesiologi dan Terapi Intensif, Fakultas Kedokteran, Universitas Diponegoro/ RSUP Dr. Kariadi Semarang, Indonesia
Published: 1 Nov 2012.
Open Access
Citation Format:
Article Info
Section: Penelitian
Language: ID
Full Text:
In Vol 4, No 3 (2012): Jurnal Anestesiologi Indonesia
Statistics: 1221 164
Abstract

Latar belakang: Heparin telah digunakan sebagai terapi maupun sebagai profilaksis primer TVD, walaupun keamanan heparin khususnya pada pasien kritis yang memiliki risiko tinggi perdarahan masih merupakan subyek perdebatan. Belum ada studi prospektif komparatif yang tegas menunjukkan efektivitas dan keamanan pemberian heparin subkutan sebagai profilaksis TVD pada pasien kritis di ICU.

Tujuan: Untuk mengetahui perbedaan pengaruh pemberian heparin subkutan dibandingkan intravena sebagai profilaksis TVD terhadap nilai aPTT dan jumlah trombosit pada pasien kritis di ICU.

Metode: Uji klinik dilakukan pada 30 pasien selama 3 hari dengan pemberian heparin subkutan 5000 IU b.i.d sebagai kelompok SK (n=15) dan heparin 500 IU/jam intravena sebagai kelompok IV (n=15) kemudian dibandingkan beberapa parameter koagulasi (D- dimer, aPTT dan trombosit) pada pasien kritis di ICU.

Hasil: Setelah 3 hari diberikan profilaksis TVD didapatkan hasil yang bermakna penurunan kadar D-dimer pada kedua kelompok, kelompok SK 959.73(1127.539) (p=0.05) dan kelompok IV 1621.33(1041.654) (p=0.00). Tetapi didapatkan hasil yang tidak bermakna pada perubahan nilai aPTT, kelompok SK 0.032(0.5284) (p=0.815) dan kelompok IV 0.068(0.5718) (p=0.652). Perubahan jumlah trombosit didapatkan hasil tidak bermakna pada kelompok SK 413.3(51489.76) (p=0.815) sedangkan pada kelompok IV didapatkan perubahan yang bermakna dalam penurunan jumlah trombosit 30186.6(53488.86) (p=0.046).

Simpulan: Pemberian heparin subkutan 5000 IU b.i.d dan heparin 500 IU/jam intravena sebagai profilaksis TVD secara bermakna dapat menurunkan kadar D-dimer. Tetapi didapatkan hasil yang tidak bermakna pada perubahan nilai aPTT dan perubahan yang bermakna pada kelompok heparin IV dalam penurunan jumlah trombosit

Keywords
heparin; TVD; aPTT; jumlah trombosit

Article Metrics:

  1. Goldhaber SZ. Epidemiology of- pulmonary embolism. Semin Vasc Med 2001 ;1:139-146
  2. Stratton MA, Anderson FA, Bussey HI, et al. Preventionof-venous thromboembolism: Adherence to the 1995American College of Chest Physicians consensus guidelinesfor surgical patients. Arch Intern Med. 2000;160:334-340
  3. Kahn SR. Frequency and determinants of the postthromboticsyndrome after venous thromboembolism.CurtOpinPulm Med 2006;12:299-303
  4. Cade JF.High risk of the critically ill for venous thromboembolism.Crit Care Med 1982;10:448-450
  5. Belch J J, Lowe GD, Ward AG, et al. Prevention of deep veinthrombosis in medical patients by low-dose heparin. ScottMedJ 1981;26:115-117
  6. Hirsch DR, Ingenito EP, Goldhaber SZ. Prevalence of deepvenous thrombosis among patients in medical intensivecare.JAMA 1995;274:335-337
  7. Silverstein MD, Heir JA, Mohr DN,et at. Trends in the incidence of deepvein thrombosis and pulmonary embolism:A 25-year population-basedstudy. Arch Intern Med1998;158:585-593
  8. McGarry LJ, Thompson D. Retrospectivedatabase analysis of theprevention of venous thromboembolismwith low-molecular-weightheparin in acutely ill medical inpatientsin community practice. ClinTher 2004;26:419-430
  9. Heit JA. Venous thromboembolism epidemiology: implications for prevention and management. SeminThrombHemost 2002, 28(Suppl 2):3-13
  10. White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107(Suppl):I4-I8
  11. Heit JA, Cohen AT, Anderson FJ.Estimated annual number of incident and recurrent, non-fatal venous thromboembolism (VTE) events in the US.Blood.2005; 106: 11
  12. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000 (Mar 27);160(6):809–15
  13. O'Brien JA, Caro JJ. Direct medicalcost of managing deep vein thrombosisaccording to the occurrence ofcomplications.Pharmacoeconomics2002;20:603-615
  14. Anderson FA Jr, Wheeler HB,Goldberg RJ, et al.A population-basedperspective of the hospitalincidence and case-fatality ratesof deep vein thrombosis and pulmonaryembolism.The WorcesterDVT Study.Arch Intern Med 1991;151:933-938
  15. Prandoni P, Lensing AW, CogoA, etal. The long-term clinical course ofacute deep venous thrombosis.AnnIntern Med 1996;125:1-7
  16. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism: the eight american college of chest physicians evidence-based clinical practice guidelines. Chest 2008;133;381S-453S
  17. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease* :american college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133; 454S-545S
  18. Hirsh J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI. Parenteral anticoagulants* :american college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133;141S-159S
  19. Peterson D, Harward S, Lawson J.H. Anticoagulation strategies for venous thromboembolism. Perspect Vasc Surg Endovasc Ther 2009; 21;125
  20. Schulman S, Beyth RJ, Kearon C, Levine MN. Hemorrhagic complications of anticoagulant and thrombolytic treatment :american college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133;257S-298S
  21. Prandoni P, Carnovali M, Marchiori A, et al. Subcutaneous adjusted dose unfractionated heparin vs fixed-dose low-molecular-weight heparin in the initial treatment of venous thromboembolism. Arch Intern Med 2004;164:1077-83
  22. Kearon C, Ginsberg JS, Julian JA, et al. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism.JAMA 2006;296:935- 42
  23. Kleber FX, Witt C, MD, Vogel G, Koppenhagen K, Schomaker U, Flosbach CW. Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J 2003;145:614-21
  24. Kanaan AO, Silva MA, Donovan JL, Roy T, AI-Homsi S. Meta-Analysis of venous thromboembolism prophylaxis in medically ill patients.Clin Therapeutics2007;29, (11): 2395- 2405
  25. Nutescu EA, Spinler SA, Wittkowsky A, Dager WE. Low-molecularweight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings. Ann Pharmacother 2009;43:1064-83
  26. Levey SA, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47
  27. Metzger NL, Chesson MM. Subcutaneous Unfractionated Heparin for Treatment of Venous Thromboembolism in End-Stage Renal Disease. Ann Pharmacother 2010;44:2023-7
  28. Doyle DJ, Turpie AGG, Hirsh J, Best C, Kinch D, Levine MN, Gent M. Adjusted subcutaneous heparin or continuous intravenous heparin in patients with acute deep vein thrombosis: a randomized trial. Annals of Int Med 1987;107:441-445
  29. Bentley PG, Kakkar VV, Scully MF, MacGregor IR, Webb P, Chan P, Jones N. An objective study of alternative methods of heparin administration.Thrombosis Research 1980;18;177-187
  30. Andersson G, Fagrell B, Holmgren K, Johnsson H, Ljungberg B, Nilsson E, Wilhelmsson S, ZetterquistS.Subcutaneous Administration of heparin: a randomized comparison with intravenous administration of heparin to patients with deep-vein thrombosis. Thrombosis Research 1982;27;631-639
  31. Robinson AM, McLean KA, Greaves M, Channer KS. Subcutaneous versus intravenous administration of heparin in the treatment of deep vein thrombosis; which do patients prefer? a randomized cross-over study. Postgrad Med J 1993;69:115 – 116
  32. Hommes DW, Bura A, Mazzolai L, Buller HR, ten Cate JW. Subcutaneous heparin compared with continuous intravenous heparin administration in the initial treatment of deep vein thrombosis. Ann Intern Med 1992;116:279-84
  33. Suharti C. Dasar-DasarHemostasis.Dalam :Aru W Sundarudkk. (editor) Buku Ajar IlmuPenyakitDalam.Edisikeempat. Jakarta. PusatPenerbitanDepartemenIlmuPenyakitDalam. Edisikeempat. Jakarta. PusatPenerbitanDepartemenIlmuPenyakitDalam FKUI.2006.
  34. Oesman F, Setiabudy RD. FisiologiHemostasisdanFibrinolisis. Dalam :Rahajuningsih D Setiabudy (editor). HemostasisdanTrombosis. Edisiketiga. Jakarta: BalaiPenerbit FKUI; 2007. hal.1-15
  35. Riddle JP, Aouizerat BE, Miaskowski CM, Lillicrap DP. Theories of blood coagulation. Journal of Pediatric Oncology Nursing 2007; 24:123-31
  36. Barbui T, Carobbio A, Rambaldi A, Finazzi G. Perspectives on thrombosis in essential thrombocythemia and polycythemia vera: is leukocytosis a causative factor? Blood 2009; 114:759
  37. Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematol Oncol Clin North Am. Aug 2007;21(4):685-96, vi

The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to JAI (Jurnal Anestesiologi Indonesia) and Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University as publisher of the journal. Copyright encompasses exclusive rights to reproduce and deliver the article in all form and media, including reprints, photographs, microfilms, and any other similar reproductions, as well as translations. 

JAI (Jurnal Anestesiologi Indonesia) and Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University and the Editors make every effort to ensure that no wrong or misleading data, opinions or statements be published in the journal. In any way, the contents of the articles and advertisements published in JAI (Jurnal Anestesiologi Indonesia) are the sole and exclusive responsibility of their respective authors and advertisers.

The Copyright Transfer Form can be downloaded here:[Copyright Transfer Form JAI]. The copyright form should be signed originally and send to the Editorial Office in the form of original mail, scanned document:  

 

Uripno Budiono (Editor-in-Chief)

Editorial Office of JAI (Jurnal Anestesiologi Indonesia

Department of Anesthesiology and Intensive Theraphy, Faculty of Medicine, Diponegoro University/ Dr. Kariadi General Hospital Medical Center (RSUP Dr. Kariadi)

Jl. Dr. Soetomo No. 16 Semarang, Central Java, Indonesia, 50231

Telp. : (024) 8444346

Email : janestesiolgo@gmail.com