Latar Belakang : Kemoterapi sitostatika dilaporkan meningkatkan
aktivitas koagulasi (D-dimer meningkat) dan mengubah hypercoagulable state
menjadi hiperkoagulasi. Hypercoagulable state adalah suatu kondisi yang
berpotensi untuk terjadinya trombosis (misal pada pasien kanker) yang ditandai
dengan perubahan aktivitas koagulasi pra trombin (peningkatan fragmen
protrombin 1-2 atau kompleks TAT) dengan D-dimer yang normal.
Hiperkoagulasi ditandai dengan PT dan aPTT memendek sementara fibrinogen
dan D-dimer meningkat. Insidens kemoterapi menimbulkan trombus pertahun
sekitar 11 %. Insidens tromboemboli vena pada pasien yang dirawat inap yang
mendapat kemoterapi pada populasi Thailand ttinggi, terutama pada pemberian
terapi. Sampai saat ini belum ada laporan mengenai insidens TEV pada pasien
kanker limfoma yang menjalani kemoterapi di Indonesia.
Tujuan Penelitian : Menilai aktivitas koagulasi (D-dimer) dan sistem
koagulasi (PT,aPTT, fibrinogen) pada pasien limfoma non Hodgkin yang
mendapatkan kemoterapi R-CHOP
Metode Penelitian : Penelitian pre dan post prospektif pada pasien
limfoma non Hodgkin yang menjalani kemoterapi dengan rejimen R-CHOP
secara consecutive sampling di Ruang Rawat Inap Gedung A RSCM dan Ruang
Rawat Inap RS Kanker Dharmais. Penelitian dilakukan pada April-Juni 2019.
Pasien diambil darah dengan parameter aktivitas koagulasi (D-dimer) dan system
koagulasi (PT, aPTT, fibrinogen). Analisis data untuk melihat perubahan rerata
pre dan post kemoterapi dilakukan uji t berpasangan (distribusi normal) dan uji
Wilcoxon (tidak terdistribusi normal).
Hasil Penelitian : Sebanyak 33 pasien dilibatkan dalam penelitian ini.
Terdapat peningkatan D-dimer secara bermakna (p : 0.046), pemendekkan PT
(0.048) dan aPTT ( <0.001) secara bermakna, disertai penurunan kadar fibrinogen
namun tidak signifikan secara statistika
Kesimpulan : Peningkatan D dimer secara bermakna, disertai
pemendekkan PT dan aPTT secara bermakna, sedangkan fibrinogen mengalami
penurunan walaupun tidak signifikan secara statistik. Hal ini menunjukkan
kecenderungan pasien mengalami status hiperkoagulasi
Background : Cytostatic chemotherapy is reported to increase
coagulation activity (increased D-dimer) and change the hypercoagulable state
into hypercoagulation. Hypercoagulable state is a condition that has the potential
for thrombosis (for example in cancer patients) characterized by changes in prethrombin
coagulation activity (increase in prothrombin fragments 1-2 or TAT
complex) with normal D-dimers. Hypercoagulation is characterized by PT and
aPTT shortening while fibrinogen and D-dimer are increasing. The incidence of
chemotherapy causes thrombus annually about 11%. The incidence of venous
thromboembolism in hospitalized patients receiving chemotherapy in the high
Thai population, especially in the administration of therapy. To date there have
been no reports of TEV incidence in lymphoma cancer patients undergoing
chemotherapy in Indonesia.
Objectives : Assess the activity of coagulation (D-dimers) and
coagulation systems (PT, aPTT, fibrinogen) in non-Hodgkins lymphoma patients
receiving R-CHOP chemotherapy
Methods : Pre and post prospective studies in non-Hodgkins
lymphoma patients undergoing chemotherapy with the R-CHOP regimen by
consecutive sampling in the Inpatient Room of Building A RSCM and the
Inpatient Room of Dharmais Cancer Hospital. The study was conducted in April-
June 2019. Patients were taken blood with parameters of coagulation activity (Ddimer)
and coagulation system (PT, aPTT, fibrinogen). Data analysis to see
changes in mean pre and post chemotherapy was performed paired t test (normal
distribution) and Wilcoxon test (not normally distributed).
Results: A total of 33 patients were included in this study. There was a significant
increase in D-dimer (p: 0.046), PT shortening (0.048) and aPTT (<0.001)
significantly, accompanied by a decrease in fibrinogen levels but not statistically significant
Conclusion : D significantly increased dimer, accompanied by
significant shortening of PT and aPTT, whereas fibrinogen decreased even though
it was not statistically significant. This shows the tendency of patients to
experience hypercoagulable state
SP-Maya Hestiningtyas Arini Djohansjah.pdf :: Unduh