Tesis

Perbandingan Kadar Fibrinogen, D-dimer, dan Dosis Heparin Terapeutik pada Pasien Deep Vein Thrombosis (DVT) dengan Keganasan atau Non Keganasan = Comparison of Fibrinogen, D-dimer and Therapeutic Heparin Doses in Malignant or Non-Malignant Deep Vein Thrombosis (DVT) Patients.

Latar Belakang: Deep Vein Thrombosis (DVT) merupakan salah satu masalah dengan angka mortalitas jangka pendek dan morbiditas jangka panjang. Sebanyak 60% kasus DVT tidak memiliki gejala. Seiring bertambahnya usia, insiden DVT akan terus meningkat. Sekitar 1 dari 100.000 orang tiap tahunnya akan menderita DVT dibawah usia 50 tahun dan meningkat menjadi 1000 dari 100.000 per tahun di usia 85 tahun. Pada satu pertiga kasus bermanifestasi sebagai emboli paru, sedangkan dua pertiga lainnya hanya sebatas DVT. Terdapat kenaikan kadar fibrinogen maupun d-dimer pada pasien dengan keganasan.Penelitian ini bertujuan menganalisa dan membandingkan kadar fibrinogen, ddimer dan dosis heparin terapeutik pada pasien DVT dengan keganasan dan non keganasan. Metode: Penelitian ini merupakan kohort retrospektif menggunakan rekam medis di RS Cipto Mangunkusumo. Variabel bebas adalah terapi pada pasien DVT sedangan variabel terikatnya adalah kadar D-dimer, fibrinogen dan aPTT terapeutik. Analisa statistic menggunakan SPSS versi 20, nilai p < 0.05 menunjukkan terdapat hubungan bermakna secara statistik. Hasil: 63 pasien masuk dalam penelitian, didapatkan pasien DVT dengan keganasan sebanyak 33 pasien (52,4%) dan pasien DVT non keganasan sebanyak 30 pasien (47,6%). Kadar fibrinogen, D-dimer awal dan akhir pada pasien DVT dengan keganasan memiliki kadar yang lebih tinggi secara bermakna dibandingkan dengan DVT non keganasan (p < 0,001). Terdapat perbedaan signifikan pada penurunan D-dimer pasien DVT dengan keganasan dibandingakan dengan pasien DVT non kegananasan. Dosis heparin awal pasien DVT dengan keganasan memiliki nilai tidak bermakna dibandingkan dengan DVT non keganasan (p > 0,001). Dosis heparin terapeutik pada pasien DVT dengan keganasan bermakna signifikan lebih tinggi dibandingkan DVT non keganasan (p < 0,001). Simpulan: Terdapat perbedaan yang bermakna pada kadar fibrinogen, d-dimer awal dan akhir yang bermakna antara pasien DVT keganasan dengan pasien DVT non keganasan. Terdapat perbedaan yang bermakna pada penurunan D-dimer pasien DVT dengan keganasan dan DVT non keganasan. Ditemukan perbedaan bermakna pada dosis heparin terapeutik pasien DVT dengan keganasan dan DVT non keganasan.
Kata kunci: deep vein thrombosis, fibrinogen, d-dimer, aPTT terapeutik, dosis heparin terapeutik.


Background: Deep Vein Thrombosis (DVT) is a problem with short-term mortality and long-term morbidity. As many as 60% of DVT cases have no symptoms. With age, the incidence of DVT will continue to increase. About 1 in 100,000 people each year will suffer from DVT under the age of 50 years and this increases to 1000 from 100,000 per year at the age of 85 years. In one third of cases it manifests as a pulmonary embolism, while in the other two thirds only a DVT is present. There is an increase in the levels of fibrinogen and d-dimer in patients with malignancy. This study aims to analyze and compare the levels of fibrinogen, d-dimer and therapeutic doses of heparin in malignant and non-malignant DVT patients. Method: This study is a retrospective cohort using medical records at Cipto Mangunkusumo Hospital. The independent variable is therapy in DVT patients while the dependent variable is the level of D-dimer, fibrinogen and therapeutic aPTT. Statistical analysis using SPSS version 20, p value < 0.05 indicates that there is a statistically significant relationship. Results: 63 patients were included in the study, 33 patients with malignant DVT were found (52.4%) and 30 patients with non-malignant DVT (47.6%). The initial levels of fibrinogen in patient with malignant DVT were significantly higher than those of non malignant DVT (p < 0.05). The final levels of fibrinogen in patient with malignant DVT were significant higher than those of non malignant DVT (p < 0,05).There was significant higher of D-dimer initial levels beetween patient with malignant DVT and patient with non malignant DVT (p < 0,05). There was significant higher of D-dimer final levels beetween patient with malignant DVT and patient with non malignant DVT (p < 0,05). There was a significant difference in the decrease of d-dimer levels between DVT patients with malignancy compared to non-malignant DVT patients who were given heparin therapy. The initial heparin dose in patients with malignant DVT had no significant value compared to non malignant DVT (p > 0.001). The therapeutic dose of heparin in patients with malignant DVT was significantly higher than that of non malignant DVT (p < 0.001). Conclusion: There was a significant difference in the levels of fibrinogen and D- dimer initial and final which was significant between malignant DVT patients and nonmalignant DVT patients. There is a significant difference in the decrease in D-dimer in patients with malignant DVT and non-malignant DVT. A significant difference was found in the therapeutic dose of heparin in patients with malignant DVT and nonmalignant DVT.
Keywords: deep vein thrombosis, fibrinogen, d-dimer, therapeutic aPTT, therapeutic heparin dose.