Penggunaan Antikoagulan Pada Pasien Covid-19 di RS PKU Muhammadiyah Bantul Periode Maret 2020 - Maret 2021

https://doi.org/10.22146/farmaseutik.v18i4.78638

Iin Ike Ardiani(1), Woro Supadmi(2*), Endang Yuniarti(3)

(1) Fakultas Farmasi, Universitas Ahmad Dahlan
(2) Fakultas Farmasi, Universitas Ahmad Dahlan
(3) Rumah Sakit PKU Muhammadiyah Yogyakarta
(*) Corresponding Author

Abstract


Covid-19 menyebabkan meningkatnya nilai D-Dimer. Penatalaksanaan terapi Covid19 menggunakan antikoagulan, antikoagulan mempunyai efek samping perdarahan yang harus dipantau seperti epistaksis, hematuria, hematoma, gingivitis, dan melena. Tujuan penelitian untuk mengetahui karakteristik pasien, ketepatan regimen terapi Invicloth dan Lovenox, perbaikan kondisi pasien dan efek samping berdasarkan respon klinis, hubungan antara ketepatan regimen terapi dengan perbaikan kondisi klinis pasien dan kejadian efek samping antikoagulan. Jenis penelitian deskriptif-analitik dengan rancangan cohort, pengambilan data secara retrospektif. Data yang diambil adalah rekam medik pasien dewasa yang terdiagnosis terkonfirmasi Covid-19. Sampel yang diambil adalah semua pasien terkonfirmasi Covid-19 yang menggunakan antikoagulan Invicloth dan Lovenox selama periode Maret 2020-Maret 2021 dengan kriteria inklusi dan eksklusi. Data yang diambil meliputi usia, jenis kelamin, diagnosis Covid-19 atau bersama komorbid lain, data klinis, data obyektif dan subyektif, lama rawat inap serta data profil penggunaan antikoagulan. Perbaikan klinis yang diamati berupa DDimer, trombosit, Hb, dan APTT/PTT. Data dianalisis univariat dan bivariat untuk mengetahui hubungan antara ketepatan regimen terapi dengan perbaikan klinis dengan chi-square. Hasil penelitian menunjukkan 75 pasien memenuhi kriteria inklusi. Pasien laki-laki lebih banyak 61.3%. Usia ≤ 60 tahun adalah usia yang paling tinggi 73.4%. Invicloth digunakan paling sering 90.7%, Lovenox 9.3%. Lama penggunaan Invicloth dan Lovenox < 7 hari 62.6%. Distribusi pasien kebanyakan dengan komorbid 66.6%, terbesar Diabetes Melitus 20%. Efek samping Invicloth muncul trombositopenia 3 orang(4%), anemia 9 orang (12%) dan adanya perdarahan (BAB diare berdarah 2,6% dan muntah darah 1,3%), sedangkan Lovenox 16% (nilai APTT tinggi namun tidak tampak tanda perdarahan pada pasien). Pasien membaik 80%. Ketepatan regimen Invicloth 72% dan Lovenox 2,6%. Rata-rata D-Dimer saat pemeriksaan awal 1.156 ng/mL (nilai normal D-dimer < 0.5 ng/mL) sedangkan pemeriksaan akhir rata-rata 0.58 ng/mL. Hubungan ketepatan regimen antikoagulan dengan perbaikan klinis dan efek sampingnya diuji secara chi-square didapat D-dimer p=0.626, trombosit p=1.00, Hb p=0,49, APTT/PTT p=1,00, dan efek samping antikoagulan p=0.259, dimana p> 0.05. Tidak ada hubungan antara ketepatan regimen antikoagulan dengan perbaikan klinis pasien dan efek samping antikoagulan.

Keywords


Covid-19; ketepatan regimen; Invicloth; Lovenox; respon klinis

Full Text:

PDF


References

Aditia, A., Adhi, M. P., Rohman, B. F., & Susianto, O. (2020). Tatalaksana Komplikasi Tromboemboli Terkonfirmasi Corona Virus Disease-19 pada Pasien Management of Thromboembolic Complications in Confirmed Corona Virus Disease -19 Patients. 12,34–48.

Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: A Review of the Pharmacology, Dosing, and Complications. Curr Emerg Hosp Med Rep. 2013;1(2):83-97. doi:10.1007/s40138-013-0014-6

Belen, F. B., & Sarıalioğlu, A. F. (2020). Pulmonary intravascular coagulation in COVID

‑ 19 : possible pathogenesis and recommendations on anticoagulant / thrombolytic therapy. Journal of Thrombosis and Thrombolysis, 0123456789, 3–5. https://doi.org/10.1007/s11239-020-02129-0

Barnes GD, Burnett A, Allen A, et al. Thromboembolism and anticoagulant therapy duringthe COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. JThromb Thrombolysis. 2020;50(1):72-81. doi:10.1007/s11239-020-02138-z

Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis.

2020;50(1):54-67. doi:10.1007/s11239-020-02134-3

Cate, H. (2020). Thrombosis management in times of COVID-19 epidemy ; a Dutchperspective. 1–2.

Cui, S., Chen, S., Li, X., Liu, S., & Wang, F. (2020). Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 18(6), 1421–1424. https://doi.org/10.1111/jth.14830

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Published Online, January 29, 2020 https://doi.org/10.1016/S0140-6736(20)30211-7


Eurich DT, Majumdar SR, Wozniak LA, et al. Addressing the gaps in diabetes care in first nations communities with the reorganizing the approach to diabetes through the application of registries (RADAR): the project protocol. BMC Health Serv Res.

2017;17(1):1-9. doi:10.1186/s12913-017-2049-y

Flumignan RLG, Tinôco JDDS, Pascoal PIF, Areias LL, Cossi MS, Fernandes MICD, Costa IKF, Souza L, Matar CF, Tendal B, Trevisani VFM, Atallah ÁN, Nakano LCU (2020). Prophylactic anticoagulants for people hospitalised with COVID-19. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD013739. DOI: 10.1002/14651858.CD013739.

Farghaly, S., & Makboul, M. (2021). Correlation between age, sex, and severity of Coronavirus disease-19 based on chest computed tomography severity scoring system. Egyptian Journal of Radiology and Nuclear Medicine, 52(1), 1–8. https://doi.org/10.1186/s43055-021-00408-1

Hamid, S., Mir, M. Y., & Rohela, G. K. (2020). Novel coronavirus disease (COVID-19): a pandemic (epidemiology, pathogenesis and potential therapeutics). New Microbes and New Infections, 35, 100679. https://doi.org/10.1016/j.nmni.2020.100679

Isbaniah, F. (2020). Pedoman Pencegahan dan Pengendalian Coronavirus Disease (COVID- 19). Germas, 0–115.

Joly, B. S., Siguret, V., & Veyradier, A. (2020). Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19. Intensive Care Medicine, 46(8), 1603–1606. https://doi.org/10.1007/s00134-020-06088-1

Kemenkes (2022). Cedera miokardium pada infeksi COVID-19. In Pedoman tatalaksana COVID-19 edisi 4.

Kemenkes (2020). Pedoman Tatalaksana Covid-19 Edisi 3 Tim Editor Perhimpunan Dokter Paru Indonesia (PDPI) Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI) Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI) Perhimpunan Dokter Anestesiologi dan Terapi.

Khairunnisa z, K. z, Sofia, R., & Magfirah, S. (2021). Hubungan Karakteristik Dan Tingkat Pengetahuan Dengan Perilaku Pencegahan Covid-19Pada Masyarakat Desa Paya Bujok Blang Pase Kota Langsa. AVERROUS: Jurnal Kedokteran Dan Kesehatan Malikussaleh, 7(1), 53. https://doi.org/10.29103/averrous.v7i1.4395

Kemenkes RI. (2020). Peta Sebaran COVID-19. In Gugus Tugas Percepatan Penanganan COVID-19 (pp. 3–4).

Klein, D. E., Libman, R., Kirsch, C., & Arora, R. (2020). Cerebral venous thrombosis: Atypical presentation of COVID-19 in the young. Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 8 (August), 2020: 104989

Li, F. (2016). Structure, Function, and Evolution of Coronavirus Spike Proteins. Annual Review of Virology, 3, 237–261. https://doi.org/10.1146/annurev-virology-110615-

042301

Lodigiani, C., Iapichino, G., Carenzo, L., Cecconi, M., & Ferrazzi, P. (2020). Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Center for Thrombosis and Hemorrhagic Diseases https://doi.org/10.1016/j.thromres.2020.04.024

Lexicomp. (2022). Drug Information Handbook 22th edition pdf

Meyler’s. (n.d.). Side Effects of Drugs Annuals 23-27 and/or the 14th edition of Meyler’s Side Effects of Drugs.

Mucha, S. R., Dugar, S., McCrae, K., Joseph, D. E., Bartholomew, J., Sacha, G., & Militello,

M. (2020). Coagulopathy in COVID-19: Posted april 24, 2020. Cleveland Clinic Journal of Medicine, 87(5), 1–6. https://doi.org/10.3949/CCJM.87A.CCC024

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)

Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb. 2020;26. doi:10.1177/1076029620938149


Nutescu, E. A., Burnett, A., Fanikos, J., Spinler, S., & Wittkowsky, A. (2016). Pharmacology of anticoagulants used in the treatment of venous thromboembolism. Journal of Thrombosis and Thrombolysis, 41(1), 15–31. https://doi.org/10.1007/s11239-015-1314-

3

Rusdiana, T., & Akbar, R. (2020). Perkembangan Terkini Terapi Antikoagulan Pada Pasien Covid-19 Bergejala Berat. Jurnal Sains Farmasi & Klinis, 7(3), 248. https://doi.org/10.25077/jsfk.7.3.248-254.2020

Roosy Budyastiti (2021). Evaluasi Penggunaan Heparin di RS PKU Muhammadiyah Yogyakarta Tahun 2019-2020. Universitas Islam Indonesia Yogyakarta

Santoliquido, A., Porfidia, A., Nesci, A., De Matteis, G., Marrone, G., Porceddu, E., Cammà, G., Giarretta, I., Fantoni, M., Landi, F., Gasbarrini, A., Pola, R., D’Alfonso, M. E., & Lo Monaco, M. R. (2020). Incidence of deep vein thrombosis among non-ICU patients hospitalized for COVID-19 despite pharmacological thromboprophylaxis. Journal of Thrombosis and Haemostasis, 18(9), 2358–2363. https://doi.org/10.1111/jth.14992

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. 2020;(February):844-847. doi:10.1111/jth.14768

Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-1026. doi:10.1111/jth.14810

Viggiano, D., Wagner, C. A., Martino, G., Nedergaard, M., Zoccali, C., Unwin, R., & Capasso, G. (2020). Mechanisms of cognitive dysfunction in CKD. Nature Reviews Nephrology, 16(8), 452–469. https://doi.org/10.1038/s41581-020-0266-9

Weiss, P., & Murdoch, D. R. (2020). Clinical course and mortality risk of severe COVID-19 COVID-19 : towards controlling of a pandemic. The Lancet, 395(10229), 1014–1015. https://doi.org/10.1016/S0140-6736(20)30633-4

WHO. (2020). Tatalaksana klinis infeksi saluran pernapasan akut berat ( SARI ) suspek penyakit COVID-19. World Health Organization, 4(March), 1–25.

WHO. (2021). Clinical management Clinical management : Living guidance COVID-19.

World Health Organization, January.

Willim, H. A., Hardigaloeh, A. T., & Supit, A. I. (2020). Koagulopati pada Coronavirus Disease -2019 ( COVID-19 ): Tinjauan pustaka. Intisari Sains Medis, 11(3), 749–756. https://doi.org/10.15562/ism.v11i3.766



DOI: https://doi.org/10.22146/farmaseutik.v18i4.78638

Article Metrics

Abstract views : 1472 | views : 1365

Refbacks

  • There are currently no refbacks.


Majalah Farmaseutik Indexed by:

   
 
Creative Commons Licence
 
 
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.