Skripsi

Hubungan Pemberian Heparin terhadap Kadar D-Dimer pada Pasien Covid-19 Derajat Sedang = Relationship between Heparin Administration and D-Dimer Levels in Patients with Moderate Covid-19.

Latar Belakang COVID-19 yang disebabkan oleh virus SARS-CoV-2 telah menginfeksi jutaan orang di dunia dan menyebabkan berbagai komplikasi sistemik, termasuk koagulopati atau gangguan pembekuan darah. Peningkatan kadar D-dimer telah dikaitkan dengan risiko trombosis dan mortalitas yang lebih tinggi. Pemberian heparin sebagai antikoagulan diharapkan dapat mengurangi kadar D-dimer dan risiko komplikasi trombotik pada pasien COVID-19 derajat sedang. Metode Penelitian ini menggunakan desain observasional kohort retrospektif untuk menilai hubungan antara dosis heparin dan kadar D-dimer pada pasien COVID-19 derajat sedang. Data demografi, jenis dan dosis heparin yang diberikan, serta kadar D-dimer sebelum dan sesudah pemberian heparin dianalisis dari rekam medis pasien. Hasil Pemberian heparin terbukti menurunkan kadar D-dimer pada sebagian besar pasien. Penurunan yang signifikan terjadi pada pasien COVID-19 derajat sedang, di mana kadar D-dimer berkurang secara signifikan sebelum dan setelah pemberian heparin. Nilai median D-dimer turun dari 1260 (400-20.230) ng/mL menjadi 605 (190-2150) ng/mL dengan nilai p < 0,05. Penurunan terbesar terlihat pada pasien yang menerima kombinasi dua jenis heparin, yaitu Enoksaparin 6000 IU dan Fondaparinuks, dengan kadar D-dimer menurun dari 20.230 ng/mL menjadi 1.000 ng/mL (selisih sebesar 19.230 ng/mL). Kesimpulan Pemberian heparin efektif dalam menurunkan kadar D-dimer pada pasien COVID-19 derajat sedang, sehingga dapat mengurangi risiko komplikasi trombotik. Hasil penelitian ini dapat dijadikan dasar untuk penelitian lebih lanjut terkait dosis optimal heparin pada pasien COVID-19.
Kata Kunci: COVID-19, heparin, D-dimer, trombosis, koagulopati


Introduction COVID-19 caused by the SARS-CoV-2 virus has infected millions of people worldwide and caused various systemic complications, including coagulopathy or blood clotting disorders. Increased D-dimer levels have been associated with a higher risk of thrombosis and mortality. Administration of heparin as an anticoagulant is expected to reduce Ddimer levels and the risk of thrombotic complications in moderate COVID-19 patients. Method This study used a retrospective observational cohort design to assess the relationship between heparin dose and D-dimer levels in patients with moderate COVID-19. Demographic data, type and dose of heparin given, and D-dimer levels before and after heparin administration were analyzed from patient medical records. Results Heparin administration has been shown to reduce D-dimer levels in most patients. A significant decrease occurred in patients with moderate COVID-19, where D-dimer levels decreased significantly before and after heparin administration. Median D-dimer levels decreased from 1260 (400-20,230) ng/mL to 605 (190-2150) ng/mL with p < 0.05. The largest decrease was seen in patients receiving a combination of two types of heparin, namely Enoxaparin 6000 IU and Fondaparinux, with D-dimer levels decreasing from 20,230 ng/mL to 1,000 ng/mL (a difference of 19,230 ng/mL). Conclusion Administration of heparin is effective in reducing D-dimer levels in moderate COVID- 19 patients, thereby reducing the risk of thrombotic complications. The results of this study can be used as a basis for further research regarding the optimal dose of heparin in COVID-19 patients.
Keywords: COVID-19, heparin, D-dimer, thrombosis, coagulopathy