Tesis

Manfaat dan Keamanan Trombolisis Intravena dengan Alteplase 0,6 mg/kgBB pada Stroke Iskemik Akut < 6 Jam di RSCM = Safety and Efficacy of Intravenous Thrombolysis with Alteplase 0,6 mg/kg in Acute Ischemic Stroke at Cipto Mangunkusumo Hospital.

Latar Belakang: Stroke merupakan salah satu penyebab utama tingginya angka kematian dan disabilitas di dunia dengan etiologi utama iskemik. Stroke iskemik disebabkan emboli atau trombus yang menyumbat arteri otak sehingga timbul inti infark yang dikelilingi penumbra iskemik. Untuk mengembalikan sirkulasi penumbra iskemik diperlukan terapi reperfusi, salah satunya trombolisis intravena dengan Alteplase. Dari berbagai pusat studi penggunaan Alteplase berbeda-beda dalam waktu awitan-terapi dan dosis terapi, yaitu awitan terapi 3 hingga 6 jam dan dosis standard 0,9 mg/kgBB dibandingkan dengan dosis rendah 0,6 mg/kgBB. Metode Penelitian: Penelitian berupa studi potong lintang serial untuk menilai manfaat (persentase perbaikan NIHSS dan mRS) serta keamanan (angka kejadian perdarahan intraserebral simtomatik dan kematian) penggunaan alteplase dosis 0,6 mg/kgBB pada stroke iskemik akut < 6 jam selama periode November 2014 hingga Agustus 2017 di RSCM. Hasil: Dari 54 subjek, 33,3% mengalami perbaikan > 4 nilai NIHSS pada 24 jam pascatrombolisis. 55,4% memiliki luaran baik berdasarkan mRS 90 hari. 7,4% mengalami perdarahan intraserebral 7 hari pasca-trombolisis. Sebanyak 10,2% subjek mengalami kematian dengan 5,6% meninggal dengan penyebab serebral. Kesimpulan: Alteplase dosis 0,6 mg/kgBB bermanfaat dan aman diberikan pada stroke iskemik akut < 6 jam.
Kata Kunci : Trombolisis, Alteplase, Stroke, Indonesia


Background: Stroke is a leading cause of mortality and disability globally with major ischemic etiology. Ischemic stroke caused by thrombus or embolus that lodges in cerebral artery causing infarct core and surrounded by ischemic penumbra. To restore ischemic penumbral circulation, reperfusion therapy is required; one of them is intravenous thrombolysis with Alteplase. Many centers has different use of Alteplase within onset to treatment time and therapeutic doses, i.e. onset to treatment 3 to 6 hours and the standard dose of 0.9 mg/kg compared with low-dose 0.6 mg/kg. Methods: Serial cross sectional study to assess the efficacy (percentage improvement of NIHSS and mRS) and safety (symptomatic intracerebral haemorrhage and death) with Alteplase 0.6 mg/kg in acute ischemic stroke < 6 hours during November 2014 to August 2017 at RSCM. Result: Of 54 subjects involved, 33.3% experienced improvement > 4 point NIHSS at 24-hours post-thrombolysis. 55.4% had good outcomes based on mRS 90-days. 7.4% experienced intracerebral hemorrhage at 7-days post-thrombolysis. 10.2% of subjects suffered death with 5.6% died with cerebral causes. Conclusion: Alteplase dose 0.6 mg/kg is beneficial and safe for acute ischemic stroke < 6 hours.
Key words : Thrombolysis, Alteplase, Stroke, Indonesia