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"ABSTRAKLatar Belakang. Penegakan diagnosis DVT akut ekstremitas bawah dengan sarana diagnostik yang ada termasuk venous duplex ultrasonography VDUS masih terkendala biaya, waktu dan tenaga operator. Penelitian ini bertujuan menilai efektivitas skor Wells, kadar D-Dimer atau skor kombinasi keduanya dibandingkan dengan VDUS dalam mendeteksi kasus-kasus DVT akut ekstremitas bawah.Metode. Dilakukan studi diagnostik dengan desain cross-sectional yang dilakukan di Divisi Bedah Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM pada semua pasien dewasa dengan dugaan DVT akut ekstremitas bawah yang dikonsultasikan ke Divisi Bedah Vaskular RSCM yang dikonfirmasi dengan pemeriksaan VDUS pada periode Januari 2014 ndash; Desember 2015 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder . Analisis data berupa uji diagnostik dan diuji dengan SPSS version 17.0 for WindowsHasil. Studi melibatkan 85 orang. Didapatkan kejadian DVT akut ekstremitas bawah sebesar 65,88 . Sensitivitas dan nilai duga negatif tertinggi 100.00 didapatkan pada skor kombinasi II dan IV. Sedangkan spesifisitas tertinggi 89,66 dan nilai duga positif tertinggi 92,68 diperoleh pada skor kombinasi III. Skor dengan nilai diagnostik berimbang sensitivitas 87,50 ; spesifisitas 72,41 dijumpai pada skor Wells 3 level I.Simpulan. Skor Wells dan VDUS memiliki efektivitas sebanding dalam deteksi kasus-kasus kecurigaan DVT akut ekstremitas bawah.

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ABSTRACTIntroduction. The diagnosis of acute lower extremity DVT with available resources including VDUS was still costly, time consuming and power consumng. The purpose of this study was to evaluate effectivity of Wells score, D Dimer and combination of both compared with VDUS in detecting lower extremity DVT. Methods. This was a cross sectional diagnostic study that was carried out at Vascular and Endovascular Surgery Division of Surgery Department of FKUI RSCM between by enrolling all adult patients with suspected acute DVT of lower extremity that was consulted to Vascular Surgery Division and confirmed with VDUS study between January 2014 and December 2015 that meet inclusion and exclusion criteria. Data source was taken from medical record. Data analysis in the form of diagnostic study was performed with SPSS version 17.0 for WindowsResult. The study enrolled 85 subjects, of which 65,88 was found to have acute lower extremity DVT. The highest sensitivity and negative predictive value 100,00 was discovered in combination score II and IV. The combination score III had the highest specificity 89,66 and positive predictive value 92,68 . Whereas the most balanced diagnostic study score was the Wells score 3 Level I with sensitivity 87,50 and specificity 72,41 . Conclusion. Wells score and VDUS were equally effective in detection of lower extremity acute DVT cases. "

"Pendahuluan: Deep Vein Thrombosis (DVT) memiliki kecenderungan terus meningkat dengan koinsidensi mortalitas jangka pendek dan morbiditas jangka panjang. COVID-19 dapat menyebabkan hypercoagulable state dan menjadi predisposisi terjadinya DVT. Penelitian ini bertujuan untuk menganalisis hubungan kadar fibrinogen, D-Dimer, dan dosis heparin teraupetik berdasarkan kadar APTT dengan adanya COVID-19 pada pasien DVT. Metode: Desain penelitian komparatif dan kohort prospektif digunakan untuk membandingkan kadar fibrinogen, D-Dimer, dan dosis heparin terapeutik antara pasien COVID-19 dan non COVID-19 yang menderita DVT di RSPN Cipto Mangunkusumo pada bulan Maret 2020 – Maret 2022. Penegakan diagnosis DVT dilakukan dengan pemeriksaan ultrasonografi dan/atau computed tomography angiography (CTA) fase vena. Data variabel utama dan lainnya diperoleh dari rekam medis pasien. Uji T independen atau Mann-Whitney digunakan untuk menganalisis perbedaan nilai variabel antara kedua kelompok. Hasil: Dari total 253 sampel, tidak terdapat perbedaan karakterisitik awal antara kelompok DVT COVID-19 (n=44) dan DVT non COVID-19 (n=209), kecuali pada parameter Wells Score. Kelompok DVT COVID-19 memiliki kadar Fibrinogen, D-Dimer, dan aPTT yang lebih tinggi daripada kelompok DVT non COVID-19, baik sebelum terapi maupun sesudah terapi heparanisasi (semua nilai p =0,000). Pada akhir pengamatan, didapatkan dosis heparin terapeutik pada kelompok DVT COVID-19 lebih tinggi dibanding pada kelompok DVT non COVID-19 (30,00 (20,00-40,00)x103 U vs. 25,00 (20,00-35,00)x103 U, p=0,000). Kesimpulan: Kadar fibriongen, D-Dimer, dan dosis heparin terapeutik pada pasien DVT yang menderita COVID-19 lebih tinggi dibandingkan pada pasien DVT yang tidak menderita COVID-19. Inisiasi pemberian dosis heparin terapeutik dosis tinggi dapat dipertimbangkan pada pasien DVT dengan komorbid COVID-19 dan dipandu oleh hasil pemeriksaan biomarker koagulasi darah.

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Introduction: Deep Vein Thrombosis (DVT) has an increasing trend with a coincidence of short-term mortality and long-term morbidity. COVID-19 can cause a hypercoagulable state and predispose to DVT. This study aims to analyze the relationship between fibrinogen levels, D-Dimer, and therapeutic heparin doses based on APTT levels in the presence of COVID-19 in DVT patients. Methods: A comparative study design and a prospective cohort were used to compare levels of fibrinogen, D-Dimer, and therapeutic heparin doses between COVID-19 and non-COVID-19 patients suffering from DVT at Cipto Mangunkusumo Hospital in March 2020 – March 2022. Diagnosis of DVT was performed by ultrasound examination and/or computed tomography angiography (CTA) venous phase. The primary variable data and others were obtained from the patient's medical record. An Independent T-test or Mann-Whitney was used to analyze the differences in variable values between the two groups. Results: Of 253 samples, there was no difference in initial characteristics between the DVT COVID-19 (n=44) and non-COVID-19 DVT groups (n=209), except for the Wells Score parameter. The COVID-19 DVT group had higher levels of fibrinogen, D-Dimer, and aPTT than the non-COVID-19 DVT group, both before and after heparinization therapy (all p-values = 0.000). At the end of the follow-up period, the therapeutic dose of heparin in the COVID-19 DVT group was higher than in the non-COVID-19 DVT group (30.00 (20.00-40.00)x103 U vs. 25.00 (20.00-35.00)x103 U, p-value=0.000). Conclusion: The levels of fibrinogen, D-Dimer, and therapeutic doses of heparin in DVT patients who have COVID-19 are higher than in DVT patients who do not have COVID-19. Initiation of a higher therapeutic dose of heparin can be considered in DVT patients with comorbid COVID-19 and guided by the results of blood coagulation biomarkers."

"Latar Belakang: Pemeriksaan D-dimer dan ultrasonografi sering dipakai untuk menegakkan diagnosis trombosis vena dalam (DVT). Walaupun demikian, kedua pemeriksaan tersebut memiliki keterbatasan jika dipakai pada pasien trauma ekstremitas bawah. Tujuan dari penelitian ini adalah untuk meneliti tingkat akurasi dari pemeriksaan D-dimer atau ultrasonografi (USG) dalam mendiagnosis trombosis vena dalam pada pasien dengan trauma ekstremitas bawah. Metode: Pencarian literatur sistematis dilakukan pada database Pubmed, Cochrane, ProQuest, dan EBSCOhost. Hasil artikel yang diperoleh diskrining berdasarkan kriteria inklusi dan eksklusi. Artikel yang dimasukkan dalam tinjauan dilakukan telaah kritis menggunakan panduan dari The Center of Evidence Based-Medicine (CEEBM) University of Oxford untuk kategori systematic review dan Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Hasil: Sebanyak 89 studi teridentifikasi dari pencarian yang dilakukan. Setelah proses inklusi dan eksklusi, 3 studi dipilih untuk dimasukkan. Ketiga studi yang ditemukan membandingkan akurasi USG dan/atau D-dimer dengan venografi, flebografi, atau USG Doppler. Pemeriksaan D-dimer menunjukkan sensitivitas dan spesifisitas pasca operasi yang mencapai 95,5% dan 91,4% dengan ambang batas 10mcg/mL, namun dengan ambang batas 4,01 mcg/mL sensitivitas hanya 71.3% dan spesifitas 44.83%. Untuk sensitivitas dan spesifitas USG beragam dengan nilai sensitivitas 18%-96% dan spesifisitas 71,8-96,5%. Diskusi: Sensitivitas dan spesifisitas D-dimer dan USG cukup baik sehingga bisa dipakai untuk mendeteksi trombosis vena dalam. Untuk meningkatkan sensitivitas dan spesifitas D-dimer, ambang batas yang lebih tinggi bisa digunakan khususnya pada skrining DVT di ekstremitas bawah. Untuk sensitivitas dan spesifitas USG variatif. Hasil telaah kritis menunjukkan risiko bias yang rendah. Kesimpulan: USG dan DVT dapat menjadi alat diagnostik awal untuk mendeteksi DVT pada pasien dengan trauma ekstremitas bawah. 

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Background: The D-dimer test and ultrasonography are commonly utilized in establishing the diagnosis of deep vein thrombosis (DVT). However, both examinations have limitations when applied to patients with lower extremity trauma. The aim of this research is to investigate the accuracy of D-dimer testing or ultrasonography (USG) in diagnosing deep vein thrombosis in patients with lower extremity trauma. Methods: A systematic literature search was conducted on the Pubmed, Cochrane, ProQuest, and EBSCOhost databases. The obtained articles were screened based on inclusion and exclusion criteria. Articles included in the review underwent critical appraisal using guidelines from The Center of Evidence-Based Medicine (CEEBM) University of Oxford for systematic review categories and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Results: A total of 89 studies were identified from the conducted search. Following the inclusion and exclusion processes, 3 studies were selected for inclusion. The three identified studies compared the accuracy of ultrasonography (USG) and/or D-dimer with venography, phlebography, or Doppler ultrasonography. D-dimer testing demonstrated postoperative sensitivity and specificity reaching 95.5% and 91.4%, respectively, with a threshold of 10 mcg/mL. However, with a threshold of 4.01 mcg/mL, sensitivity was only 71.3%, and specificity was 44.83%. Sensitivity and specificity for USG varied, with sensitivity values ranging from 18% to 96% and specificity ranging from 71.8% to 96.5%. Discussion: The sensitivity and specificity of both D-dimer testing and ultrasonography (USG) are deemed adequate, rendering them suitable modalities for the detection of deep vein thrombosis (DVT). To enhance the sensitivity and specificity of D-dimer, higher thresholds can be employed, particularly in screening for DVT in the lower extremities. The sensitivity and specificity of USG are variable. Critical appraisal results indicate a low risk of bias. Conclusion: Ultrasound (USG) and D-dimer testing can serve as early diagnostic tools to detect deep vein thrombosis (DVT) in patients with lower extremity trauma."

"ABSTRAKLatar Belakang: Tromboemboli vena merupakan penyebab morbiditas dan mortalitas yang penting pada pasien kanker. Belum ada sistem skor untuk memprediksi TVD pada pasien tanpa gejala dan tanda trombosis. Sistem skor Wells merupakan sistem skoring yang awalnya digunakan untuk memprediksi TVD pada pasien dengan faktor risiko trombosis dan secara klinis diduga suspected TVD, tetapi, belum digunakan pada pasien-pasien yang tanpa gejala dan tanda TVD. Perlu dilakukan penelitian untuk mengetahui kegunaan skor Wells yang dilanjutkan dengan algoritma ACCP IX pada pasien kanker yang asimtomatik TVD.Tujuan: Mengetahui kegunaan skor Wells dalam mendiagnosis TVD pada pasien kanker yang tidak menunjukkan gejala dan tanda trombosis asimtomatik .Metode: Penelitian ini menggunakan metode potong lintang. Pasien kanker yang insidens trombosis vena dalamnya tinggi tanpa gejala dan tanda TVD , dihitung skor Wells dan dilanjutkan dengan algoritma diagnostik ACCP IX untuk mendiagnosis TVD.Hasil: Penelitian ini merekrut 100 pasien kanker yang memenuhi kriteria inklusi dan eksklusi, dan mendapatkan kejadian TVD pada 2 pasien kanker yang tidak menunjukkan gejala dan tanda TVD. Sebagian besar pasien 93 memiliki skor Wells unlikely < 2 . Hasil D-dimer lebih dari 500 g/l didapatkan pada 60 subyek penelitian. Berdasarkan uji statistik, skor Wells memiliki nilai kalibrasi yang kurang baik p < 0,01 dan nilai diskriminasi area under the curve AUC sangat lemah 47,4 . Kesimpulan: Skor Wells tidak dapat digunakan untuk memprediksi TVD pada pasien kanker yang tidak memiliki gejala dan tanda TVD. Proporsi pasien kanker dengan TVD tanpa gejala dan tanda trombosis adalah 2 . Kata Kunci: asimtomatik, kanker, skor Wells, trombosis vena dalam

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ABSTRACT Background Venous thromboembolism is the main cause of morbidity and mortality in cancer patients. Until now there was no scoring system to predict deep vein thrombosis DVT in patients with risk factors but without sign and symptoms of thrombosis. Wells score was designated to predict patients who were clinically suspected as having DVT, but not yet used for patients who were asymptomatic. We investigate whether Wells score followed by ACCP IX guideline can be used to predict DVT in cancer asymptomatic patient. Purpose To investigate the use of Wells score in diagnosing DVT in asymptomatic cancer patients. Method We conducted a cross sectional study in cancer patients whose incidence of thrombosis were highest, without sign and symptoms of DVT. We calculated the Wells score from each patients and then chose the appropriate diagnostic examination in accordance to ACCP IX guideline. Result A total of 100 patients were enrolled in this research. We found the proportion of asymptomatic DVT in cancer patients was 2 . Most of the subjects has low Wells score 93 of subjects, score 2, categorized as unlikely and high D dimer 60 of subjects, concentration of 500 g l . Based on statistical test, Wells score had a poor calibration score p 0,01 and low area under the curve 47,4 . Conclusion Wells score cannot be used as a prediction model to predict DVT in asymptomatic cancer patients. The proportion of asymptomatic DVT in cancer patients was 2 . Keywords asymptomatic, cancer, deep vein thrombosis, Wells score "

"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, d-dimer 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.

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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 non-malignant 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 non-malignant DVT."

"Latar Belakang: Deep Vein Thrombosis (DVT) adalah salah satu penyakit penyebab mortalitas jangka pendek dan morbiditas jangka panjang. Kasus DVT akan meningkat seiring bertambahnya usia. Pada pasien dengan keganasan, risiko DVT meningkat hingga 4,1 kali lipat karena kondisi hiperkoagulasi. Penatalaksanaan DVT antara lain pemberian antikoagulan dan kompresi eksterna. Penelitian ini bertujuan membandingkan luaran antropometrik tungkai pasien DVT dengan keganasan dan non-keganasan yang diterapi heparin.Metode: Kohort retrospektif menggunakan rekam medis di RS Cipto Mangunkusumo. Variabel bebas adalah status keganasan pada pasien DVT sedangkan variabel terikatnya adalah pengukuran antropometrik lingkar tungkai sebelum terapi heparin, 4 hari, dan 7 hari. Analisis statistik menggunakan SPSS versi 25, nilai p<0,05 menunjukkan kemaknaan secara statistik.Hasil: Sebanyak 63 subjek penelitian, didapatkan subjek DVT dengan keganasan sebanyak 33 subjek (52,4%) dan DVT non keganasan sebanyak 30 subjek (47,6%). Pada awal terapi, tidak terdapat perbedaan ukuran antropometrik antara DVT keganasan dan non keganasan. Pada hari ke-4 dan ke-7 terapi, terdapat perbedaan perbaikan ukuran antropometrik di mid femur, distal femur, dan mid cruris, dimana perbaikan klinis lebih tampak pada DVT non keganasan (p<0,05). Subjek DVT keganasan memiliki dosis heparin maintenance teraputik yang lebih tinggi (p=0,000), dan mencapai waktu kadar APTT terapeutik yang lebih lama (p=0,000).Kesimpulan: Subjek DVT keganasan menunjukkan perbaikan klinis yang lebih kecil dibandingkan DVT non keganasan. Selain itu, memerlukan dosis heparin maintenance terapeutik yang lebih tinggi, dan mencapai waktu kadar APTT terapeutik yang lebih lama.

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Background: Deep Vein Thrombosis (DVT) is a disease that causes short-term mortality and long-term morbidity. DVT cases will increase with age. In patients with malignancy, the risk of DVT increases up to 4.1-fold due to the hypercoagulable state. Treatment for DVT includes anticoagulants and external compression. This study aims to compare the anthropometric outcomes of the limbs of DVT patients with malignancy and non-malignancy treated with heparin.

Method: Retrospective cohort study using medical records at Cipto Mangunkusumo Hospital. The independent variable is malignancy status in DVT patients while the dependent variable is anthropometric measurements of leg circumference at first day, 4 days and 7 days heparin therapy. Statistical analysis using SPSS version 25, p<0.05 showed statistical significance.

Results: Of the 63 study subjects, 33 subjects (52.4%) had DVT with malignancy and 30 subjects (47.6%) had non-malignant DVT. At the start of therapy, there was no difference in anthropometric measures between malignant and non-malignant DVT. On the fourth and seventh days of therapy, there were differences in anthropometric size improvement in the mid femur, distal femur, and mid cruris, whereas clinical improvement was more evident in nonmalignant DVT (p<0.05). Malignant DVT subjects had higher therapeutic maintenance heparin doses (p=0.000), and achieved longer therapeutic APTT levels (p=0.000).

Conclusion: Malignant DVT subjects showed less clinical improvement than non-malignant DVT. In addition, it requires higher therapeutic maintenance heparin doses, and achieves a longer therapeutic APTT level time."

"Tujuan; membandingkan pemeriksaan trombosis vena dalam atau deep vein thrombosis (DVT) pada tungkai antara venografi 99m Tc Red Blood Cell (RBC) dengan venografi konvensional. Bahan dan Metoda: Empat belas orang diperiksa dengan venografi 99m Tc RBC dan venografi konvensional pada tungkai dengan kecurigaan DVT. Hasil : hasil pemeriksaan venografi 99m Tc RBC didapatkan 7 tungkai (38,6%) positif DVT dan yang negatif sebanyak 12 tungkai (61,4%), sedangkan hasil pemeriksaan venografi konvensional didapat 15 tungkai (78,9%) positif dan 4 tungkai (21,1 %) negatif. Dari hasil penelitian ini didapatkan bahwa venografi 99m Tc RBC mampu meningkatkan kepekaan venografi konvensional sebesar 53,3%. Kesimpulan : Venografi 99m Tc-RBC mempunyai kepekaan lebih tinggi dibandingkan venografi konvensional mendiagnosa DVT tungkai.

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Purpose: To compare diagnosis deep vein thrombosis (DVT) of lower extremities between convemional venography with 99"'Tc RBC venography. Materials and methods : Fourteen patients with suspected DVT of their lower extremities underwent 99mTc-RBC venography followed by conventional venography. Results : There are 7 legs (38,6%) positive DVT and 12 legs (61,4%) negative by 99"'Tc RBC venography and there are 15 legs (78,9%) positive DVT and 4 legs (21,1%) negative by conventional venography. From experimental analytic found 9 9t"Tc-RBC venography could be increased 53,3% sensivity of conventional venography. Conclusion: Comparing conventional venography, 99"'Tc-RBC venography has more sensitiv to make diagnosis DVT of lower extremity."

"Setidaknya 1 dari 200 pasien COVID-19 akan mengalami DVT, dan sekitar 20% kasus VTE berhubungan dengan COVID-19. Risikonya meningkat empat kali lipat pada pasien COVID-19. Munculnya berbagai faktor patofisiologis yang berkontribusi terhadap terjadinya DVT pada pasien COVID-19 menimbulkan pertanyaan menarik mengenai perbedaan dalam karakteristik luaran pasien DVT sebelum dan selama pandemi, serta variasi dalam perawatan dan hasil pasien. Desain penelitian yang digunakan adalah studi kohort retrospektif untuk melihat perbandingan karakteristik dan manajemen pasien DVT (Deep Vein Thrombosis) sebelum dan selama pandemi COVID-19. Didapatkan data 489 subyek yang diikutsertakan dalam penelitian ini dengan nilai rata-rata usianya adalah 50.72 ± 18.00. Berdasarkan waktu terkenanya DVT, dari 489 subyek tersebut, sebagian besar sampel yaitu sebanyak 344 orang (72.9%) merupakan pasien yang mengalami DVT selama pandemi COVID. Berdasarkan status mortalitas, terdapat 336 orang (71.8%) yang masih hidup setelah mengalami DVT. Berdasarkan keberadaan perdarahan hebat, sebagian besar subyek yaitu 402 orang (82.2%) tidak mengalami perdarahan hebat. Berdasarkan status rekurensi, terdapat 321 orang (65.7%) yang mengalami rekurensi yaitu kembali dirawat dengan diagnosa yang sama dalam 1 tahun pertama setelah pertama kali dirawat. Sebanyak 479 orang (97.9%) tidak mengalami emboli paru. Didapatkan nilai rata-rata durasi rawat inap selama 13.41 ± 9.89 hari. Berdasarkan hasil pemeriksaan D-Dimer, didapatkan nilai rata-rata 3008.21 ± 1494.59 ng/mL. Sedangkan hasil pemeriksaan fibrinogen, didapatkan nilai rata-rata 301.06 ± 58.63 mg/dL. Dalam melihat komparasi data DVT sebelum dan selama pandemic COVID-19, dari 4 variabel yang dilihat, hanya D-Dimer yang memiliki perbedaan yang signifikan berupa peningkatan nilai rata-rata apabila dibandingkan antara sebelum pandemic COVID (2052.34 ± 568.30 ng/mL) dan selama COVID (3363.89 ± 1573.79 ng/mL) dengan nilai p < 0.001. Hasil berbeda terjadi pada fibrinogen yang tidak memiliki perbedaan yang signifikan antara sebelum pandemic COVID (295.66 ± 57.28 mg/dL) dibandingkan dengan selama COVID (303.06 ± 59.08 mg/dL) dengan nilai p 0.223. Ditemukan bahwa pada pasien COVID-19 didapati nilai D-Dimer yang lebih tinggi (nilai p <0.001) serta fibrinogen yang lebih tinggi secara signifikan (p=0.032).

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At least 1 in 200 COVID-19 patients will experience DVT, and approximately 20% of VTE cases are related to COVID-19. The risk increases fourfold in COVID-19 patients. The emergence of various pathophysiological factors that contribute to the occurrence of DVT in COVID-19 patients raises interesting questions regarding differences in the outcome characteristics of DVT patients before and during the pandemic, as well as variations in patient care and outcomes. The research design used was a retrospective cohort study to compare the characteristics and management of DVT (Deep Vein Thrombosis) patients before and during the COVID-19 pandemic. Data were obtained for 489 subjects who were included in this study with an average age value of 50.72 ± 18.00. Based on the time of DVT, of the 489 subjects, the majority of the sample, namely 344 people (72.9%) were patients who experienced DVT during the COVID pandemic. Based on mortality status, there were 336 people (71.8%) who were still alive after experiencing DVT. Based on the presence of severe bleeding, the majority of subjects, namely 402 people (82.2%) did not experience severe bleeding. Based on recurrence status, there were 321 people (65.7%) who experienced recurrence, namely being treated again with the same diagnosis within the first year after first being treated. A total of 479 people (97.9%) did not experience pulmonary embolism. The average duration of hospitalization was 13.41 ± 9.89 days. Based on the results of the D-Dimer examination, an average value of 3008.21 ± 1494.59 ng/mL was obtained. Meanwhile, the results of the fibrinogen examination showed an average value of 301.06 ± 58.63 mg/dL. In looking at the comparison of DVT data before and during the COVID-19 pandemic, of the 4 variables looked at, only D-Dimer had a significant difference in the form of an increase in the average value when compared between before the COVID pandemic (2052.34 ± 568.30 ng/mL) and during COVID (3363.89 ± 1573.79 ng/mL) with p value < 0.001. Different results occurred in fibrinogen which did not have a significant difference between before the COVID pandemic (295.66 ± 57.28 mg/dL) compared to during COVID (303.06 ± 59.08 mg/dL) with a p value of 0.223. It was found that COVID-19 patients had higher D-Dimer values (p value <0.001) and significantly higher fibrinogen (p=0.032)."

"Kanker telah diketahui sebagai faktor risiko kuat penyebab tromboemboli, baik emboli paru maupun trombosis vena dalam. Emboli paru sendiri seringkali tidak bergejala padahal angka mortalitas bisa mencapai 80%. Tipe histopatologi adenokarsinoma merupakan salah satu faktor risiko yang meningkatkan kejadian emboli paru. Penelitian ini bertujuan untuk mengetahui proporsi kejadian emboli paru dan trombosis vena pada kelompok kemungkinan tinggi menurut skor Revisi Geneva dan memperoleh besar kemungkinan kejadian emboli paru (EP) serta hubungannya dengan tipe histopatologi kanker padat. Penelitian menggunakan potong lintang dan didapatkan 124 subjek diikutkan dalam penelitian ini yang terdiri atas kelompok adenokarsinoma dan non adenokarsinoma masing-masing sebesar 62 subjek. Berdasarkan skor Revisi Geneva, sebanyak 11 (8,8%) subjek termasuk ke dalam kelompok kemungkinan rendah, 96 (77,4%) subjek termasuk ke dalam kelompok kemungkinan menengah dan 17 (13,8%) subjek ke dalam kelompok kemungkinan tinggi. Kejadian tromboemboli vena pada kelompok kemungkinan tinggi mencapai 94,1% dengan 58,8% mengalami emboli paru dan trombosis vena dalam secara bersamaan, 11,8% hanya mengalami emboli paru saja dan 23,6% mengalami thrombosis vena dalam saja. Tipe histopatologi adenokarsinoma memiliki risiko 2,58 kali lebih tinggi untuk masuk kedalam kelompok kemungkinan kejadian tinggi emboli paru menurut skor Revisi Geneva bila dibandingkan pada subjek dengan tipe histopatologi non adenokarsinoma. Sebagai kesimpulan, kanker padat dengan tipe histopatologi adenokarsinoma meningkatkan kemungkinan kejadian emboli paru bila dibandingkan dengan tipe non adenokarsinoma.

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Cancer is widely known as a strong risk factor of thromboembolism, which consist of two kind are pulmonary embolism and deep vein thrombosis. We mainly focused on pulmonary embolism in this research. Pulmonary embolism is often asymptomatic which the mortality rate can reach 80%. Adenocarcinoma histopathological type has been proved as one of the risk factors that increase the occurance of pulmonary embolism. This research determine the proportion of pulmonary embolism and deep vein thrombosis events in high clinical probability group based on Revised Geneva score and the correlation with solid tumor histopathological type. This research used cross sectional method with 124 subjects participated in this research which consisted of 62 patients for each of adenocarcinoma and non-adeocarcinoma group. Mean of patient age was 52 years old and the sum of female participant was larger than male. Based on Revised Geneva score, 11 (8,8%) participants were in low risk clinical probability group, 96 (77,4%) participant were in middle risk clinical probability group and the rest of 17 (13,8%) participants were in high risk clinical probability group. The total event of vena thromboembolism in high risk clinical probability group reached 94,1% whereas 58,8% got both pulmonary embolism and deep vein thrombosis simultaneously, 11,8% with pulmonary embolism alone and 23,6% with vein deep vein thrombosis alone. Subjects with histopathological type of AC were 2.58 times greater to be a high-probability group of the Revised Geneva Score compared with NAC. As the conclusion, Solid cancer with histopathological type of AC increases the likelihood of PE incidence when compared with NAC."

"Latar Belakang: Sindrom pascatrombosis (PTS) diestimasikan terjadi pada 20-50% pasien dengan jarak beberapa bulan hingga 1-2 tahun pasca trombosis vena dalam DVT. Insidensi PTS akan lebih tinggi pada DVT yang ditatalaksana konservatif. Tatalaksana DVT pada COVID-19 selama ini hanya konservatif. Sampai saat ini belum ada penelitian mengenai evaluasi terjadinya sindrom pascatrombosis pada pasien DVT dengan COVID- 19.Metode: Desain penelitian yang digunakan adalah desain desain kohort retrospektif. Penelitian dilakukan di Divisi Bedah Vaskular dan Endovaskular, Departemen Medik Ilmu Bedah, Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo, Jakarta. Waktu penelitian akan berlangsung selama 6 bulan, yaitu dari bulan Desember 2022 sampai dengan Mei 2023. Dilakukan uji bivariat dan multivariat pada data yang didapat.Hasil: Didapatkan insidensi terjadinya PTS pada pasien DVT dan COVID-19 adalah 59.3%. Variabel yang meningkatkan risiko terjadinya PTS dan secara statistik bermakna menurut uji bivariat adalah riwayat DVT ipsilateral (p = 0.000), lokasi trombus Iliaka Femoral Popliteal (p = 0.000), dan derajat COVID-19 sedang berat (p = 0.000). Dari uji multivariat didapatkan y = -2.965 + 2.545X1(riwayat DVT ipsilateral) + 2.110X2 (lokasi trombus Iliaka Femoral Popliteal) + 2.679X3 (Derajat COVID-19 sedang berat).Kesimpulan: Insidensi terjadinya PTS pada pasien DVT dengan COVID-19 yang dilakukan terapi konservatif lebih meningkat. Faktor risiko yang memengaruhi terjadinya sindrom pascatrombosis secara uji statistik bivariat bermakna menurut uji bivariat adalah adanya riwayat DVT ipsilateral, lokasi trombus Iliaka Femoral Popliteal, dan derajat COVID-19 sedang berat. Dari uji multivariat didapatkan derajat COVID-19 sedang berat sebagai faktor risiko terbesar PTS sebesar 14.5X, riwayat DVT ipsilateral sebagai faktor risiko terbesar PTS sebesar 12.7X dan lokasi trombus Iliaka Femoral Popliteal sebagai faktor risiko sebesar 8.2x.

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Background: Post-thrombotic syndrome (PTS) is estimated to occur in 20-50% patients several months to 1-2 years after DVT. The incidence of PTS will be higher in DVT which is managed conservatively. So far, the management of DVT in COVID-19 has only been conservative. To date, there have been no studies regarding the evaluation of the occurrence of postthrombotic syndrome in DVT patients with COVID-19.

Methods: The design used for this research was a retrospective cohort design. The study was conducted at the Division of Vascular and Endovascular Surgery, Department of Medical Surgery, dr. Cipto Mangunkusumo, Jakarta. The research time will last for 6 months, from December 2022 to May 2023. Bivariate and multivariate tests were carried out.

Results: The incidence of PTS in DVT and COVID-19 patients was 59.3%. Variables that increasing the risk of PTS and were statistically significant according to bivariate tests were history of ipsilateral DVT (p = 0.000), Popliteal Iliac Femoral thrombus location (p = 0.000), and moderate to severe COVID-19 severity (p = 0.000). From the multivariate test, y = -0.596 + 2.545X1 (ipsilateral DVT history) + 2.110X2 (popliteal Iliac Femoral thrombus location) + (-2.679)X3 (moderate to severe COVID-19 severity).

Conclusion: The incidence of PTS in DVT patients with COVID-19 who are undergoing conservative therapy is increasing. The risk factors that influence the occurrence of postthrombotic syndrome in statistically significant bivariate tests are history of ipsilateral DVT, the location of the Iliac Femoral Popliteal thrombus, and the moderate to severe COVID-19 severity. From the multivariate test, moderate to severe COVID-19 severity was found as the biggest risk factor for PTS by 14.5-fold, history of ipsilateral DVT as risk factor for PTS by 12.7-fold and the location of the Iliac Femoral Popliteal thrombus as a risk factor for 8.2-fold."