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"Pendahuluan: Trombosis Vena Dalam pada pasien tumor ganas tungkai bawah sering kali terjadi tanpa terdeteksi. Banyak faktor seperti usia, jenis kelamin, indeks massa tubuh, jenis tumor, metastasis, fraktur patologis, differential count, kadar fibrinogen, kadar D-dimer, rasio PT, rasio APTT, Neutrophil-Lymphocyte Rasio (NLR), Platelet-Lymphocyte Rasio (PLR) dan Khorana risk score yang dapat mempengaruhi kejadian TVD.

 

Metode: Penelitian ini menggunakan desain potong lintang di RSUPN Cipto Mangunkusumo dengan total sampling. Pasien dengan tumor ganas tungkai bawah selama periode September 2020 hingga September 2021 dilihat usia, jenis kelamin, indeks massa tubuh, jenis tumor, metastasis, fraktur patologis, differential count, kadar fibrinogen, kadar D-dimer, rasio PT, rasio APTT, NLR, PLR dan Khorana risk score.

 

Hasil: Dari 45 subjek penelitian dengan tumor ganas tungkai bawah, 4 positif TVD. Dari pengujian bivariat dengan uji statistik yang sesuai, tidak didapatkan hubungan yang bermakna antara data dasar pasien seperti jenis kelamin (p= 0.608), IMT (p=0.651), tipe tumor (p=0.754), fraktur patologis (p=0.754), metastasis (p=0.679), operasi (p=1.000), lokasi tumor (0.840), venektasi (p=0.561), dan kemoterapi (p=0.617). Pada penelitian ini ditemukan hubungan signifikan antara rasio prothrombin time (PT) dengan kejadian TVD (P = 0.012). Variabel yang berkorelasi signifikan secara statistic antara lain tipe tumor (p=0.023) dan kondisi fraktur patologis (p=0.026). Terdapat hubungan yang bermakna antara variable venektasi dengan kadar D-dimer (p=0.002). Didapatkan korelasi signifikan antara kadar D-dimer dengan skor faktor risiko Khorana (p= 0.039). Didapatkan hubungan yang bermakna secara signifikan antara variabel fraktur patologis dengan kadar Rasio Platelet-Limfosit (p=0.023). Terdapat 4 variabel yang secara statistic berhubungan signifikan dengan Khorana risk score yaitu Hb (p=0.011), leukosit (p=0.005), hematokrit (p=0.047) dan D-dimer (p=0.035).

 

Kesimpulan: Angka kejadian TVD pada tumor ganas tungkai bawah cukup rendah yaitu 8.89%, di mana tidak terdapat hubungan yang bermakna secara statistic antara variabel karakterisitik maupun laboratorium darah dengan kejadian TVD

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Introduction: Deep Vein Trombosis in patients with malignant tumors of the lower limbs often goes undetected. Many factors such as age, sex, body mass index, tumor type, metastasis, pathological fracture, differential count, fibrinogen level, D-dimer level, PT rasio, APTT rasio, NLR, PLR and Khorana risk score may affect the incidence of DVT

Methods: This study used a prospective cohort design at Cipto Mangunkusumo General Hospital with total sampling. Patients with malignant tumors of the lower limbs during the period September 2020 to September 2021 were assessed for age, sex, body mass index, tumor type, metastases, pathological fractures, diff count, fibrinogen levels, D-dimer levels, PT rasio, APTT rasio, NLR, PLR and Khorana risk score

Results: Of the 45 study subjects with malignant tumors of the lower limbs, 4 were positive for TVD. From bivariate testing with appropriate statistical tests, there was no significant relationship between patient baseline data such as gender (p= 0.608), BMI (p=0.651), tumor type (p=0.754), pathological fracture (p=0.622), metastases (p=0.679), surgery (p=1,000), tumor location (0.840), venectation (p=0.561), chemotherapy (p=0.617), and Khorana risk score (p=0,552). This study found a significant relationship between the prothrombin time (PT) rasio and the incidence of DVT (P = 0.012). Variables with statistically significant correlation were tumor type (p=0.023) and pathological fracture condition (p=0.026). There was a significant relationship between the venectation variable and the level of D-dimer (p=0.002). There was a significant correlation between D-dimer levels and the Khorana risk factor score (p= 0.035). A significant relationship was found between the pathological fracture variables and the levels of the Platelet-Lymphocyte Rasio (p=0.023). There are 4 variables that are statistically significantly related to the Khorana risk score, namely Hb (p = 0.011), leukocytes (p = 0.005), hematocrit (p = 0.047) and D-dimer (p = 0.035).

Conclusion: The incidence of DVT in malignant tumors of the lower limbs is quite low, namely 8.89%, where there is no statistically significant relationship between characteristic and blood laboratory variables with the incidence of DVT.

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"Latar belakang: Pasien dengan tumor muskuloskeletal (MSK) ganas menunjukkan insidens deep vein thrombosis (DVT) bervariasi. USG Doppler berwarna merupakan modalitas terpilih untuk evaluasi DVT. Tujuan: Menilai hubungan trombus, kecepatan aliran, dan ketebalan dinding vena pada USG Doppler berwarna vena profunda ekstremitas bawah pada pasien dengan tumor primer MSK ganas. Metode: Penelitian ini menggunakan data primer dari pemeriksaan USG Doppler berwarna vena profunda ekstremitas bawah, yaitu trombus, ketebalan dinding vena, dan kecepatan aliran vena, serta data sekunder, yaitu ukuran tumor dari magnetic resonance imaging (MRI) atau computed tomography >(CT) scan dan durasi gejala tumor dari rekam medis. Penelitian dilakukan di Departemen Radiologi dan Poliklinik Orthopaedi dan Traumatologi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) bulan Agustus 2020 hingga Maret 2022. Hasil: Terdapat 10% insidens trombus pada sistem vena profunda ekstremitas bawah pada 30 subyek dengan tumor primer MSK ganas. Subyek dengan trombus cenderung memiliki volume tumor lebih besar dibandingkan tanpa trombus, namun secara statistik tidak bermakna. Kesimpulan: Dimensi dan volume tumor pada subyek dengan trombus cenderung lebih besar dibandingkan tanpa trombus. Pada penderita tumor MSK ganas, dapat ditemukan gambaran klinis dan laboratoris yang menyerupai DVT namun belum tentu didapatkan trombus, sehingga USG Doppler berwarna penting untuk membedakan ada tidaknya DVT.

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Background: Patients with malignant musculoskeletal (MSK) tumors show variable incidence of deep vein thrombosis (DVT). Color Doppler ultrasound (CDUS) is the modality of choice for DVT evaluation.

Objective: To assess the relationship of thrombus, flow velocity, and venous wall thickness on CDUS of lower extremities deep veins in patients with primary malignant MSK tumors.

Methods: Primary data from CDUS of lower extremities deep vein, including thrombus, venous wall thickness, and venous flow velocity. Tumor size was taken from magnetic resonance imaging (MRI) or computed tomography (CT) scans. Duration of tumor symptoms was taken from medical records. The study was conducted at the Department of Radiology and the Orthopaedi and Traumatology Polyclinic of the Cipto Mangunkusumo National General Hospital (RSUPNCM) from August 2020 to March 2022.

Results: There was 10% incidence of thrombus in 30 subjects. Subjects with thrombus tended to have larger tumor volume but it was not statistically significant.

Conclusion: Tumor dimensions and volume in subjects with thrombus tend to be larger than those without thrombus. In patients with malignant MSK tumors, clinical and laboratory features that resemble DVT can be found, but not necessarily a thrombus, therefore CDUS is important for distinguishing the presence or absence of DVT."

"Latar belakang: Pemeriksaan neurovaskular memegang peranan penting dalam tatalaksana sarkoma muskuloskeletal, umumnya dengan menggunakan modalitas pencitraan MRI kontras intravena. Namun ketersediaan mesin MRI di Indonesia sangat terbatas. Tujuan: Menilai peranan USG greyscale, velositas arteri dan resistive index (RI) dalam menilai keterlibatan neurovaskular oleh massa tumor. Metode: Penelitian ini menggunakan data primer dari pemeriksaan USG Doppler Berwarna sistem arteri dan MRI kontras gadolinium intravena ekstremitas inferior. Penelitian dilakukan di Departemen Radiologi dan Poliklinik Orthopaedi dan Traumatologi Rumah Sakit Umum Pusat Dr. Cipto Mangunkusumo Jakarta dari bulan Januari 2021 hingga Agustus 2022. Hasil: Akurasi USG greyscale penelitian ini didapatkan sebesar 84,2%, sensitivitas 66,7%, spesifisitas 100%, PPV 100% dan NPV 76,9%. Adanya perbedaan velositas arteri yang dibandingkan kontralateral memiliki nilai sensitivitas 66,7%, spesifisitas 100%, PPV 100% dan NPV 76,9%. Adanya perbedaan RI yang dibandingkan dengan tungkai kontralateral memiliki nilai sensitivitas 66,7%, spesifisitas 100%, PPV 100% dan NPV 76,9%. Pemeriksaan MRI kontras dalam menilai keterlibatan neurovaskular utama memiliki nilai akurasi, sensitivitas, spesifisitas, NPV dan PPV sebesar 100%. Kesimpulan: Pemeriksaan USG greyscale cenderung memiliki nilai akurasi yang baik dan memiliki potensi untuk dipertimbangkan sebagai alat diagnostik, namun penggunaannya pada pasien dengan volume tumor massif harus dihindari karena berpotensi memberikan nilai negatif palsu.

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Background: Neurovascular assessment plays an important role in the management of musculoskeletal sarcomas, commonly use contrast MRI as modality of choice. However, the availability of MRI in Indonesia is very limited. Objective: To assess the role of greyscale ultrasound, arterial velocity, and resistive index (RI) in assessing musculoskeletal sarcomas neurovascular involvement. Method: Primary data analysed from CDUS of arterial system and contrast MRI inferior extremity. The study was conducted at Department of Radiology and Orthopaedic and Traumatology Clinic of Dr. Cipto Mangungkusumo Hospital from January 2020 to August 2022. Result: The accuracy of greyscale ultrasound in this study was 84.2%, 66.7% sensitivity, 100% specificity, 100% PPV and 76.9% NPV76,9%. Arterial velocity differences compared to contralateral limb had sensitivity 66,7%, specificity100%, PPV 100% and NPV 76,9%. RI differences compared to contralateral limb had sensitivity 66,7%, specificity 100%, PPV 100% and NPV 76,9%. Contrast MRI had sensitivity, specificity, NPV and PPV 100%. Conclusion: Greyscale ultrasound has good accuracy and has the potential to be considered as diagnostic imaging modality. But the utilization of this modality in massive volume mass should be avoided since it has potential to give false negative result."

"LATAR BELAKANG: Keganasan meningkatkan risiko trombosis vena sekitar 2-7 kali. Insideni trombosis vena pada tumor ganas ovarium dilaporkan berkisar antara 5-29 . Berbagai faktor yang terkait dengan kondisi pasien usia, indeks massa tubuh, komorbid , karakteristik tumor ukuran, stadium, histologi, ascites dan terapi kemoterapi, lama pembedahan, jumlah perdarahan di laporkan dapat menjadi prediktor trombosis vena dalam TVD namun penelitian mengenai model prediksi TVD khususnya untuk populasi Indoensia masih terbatas. TUJUAN: Mengetahui faktor ndash; faktor prediktor trombosis vena dalam pada tumor ganas ovarium. DESAIN DAN METODE: Penelitian cohort prospektif ini dilakukan di RSUPN Cipto Mangunkusumo, Jakarta dan merekrut 116 pasien dengan dugaan tumor ganas ovarium yang akan menjalani operasi. Berbagai variable lain yang diduga sebagai prediktor TVD seperti kadar pra-terapi trombosit, D-Dimer, fibrinogen, usia, indeks massa tubuh IMT , komorbid, stadium, diameter, histologi, bilateralitas tumor, adanya ascites, metastasis jauh diukur dan dicatat. Pasien diikuti untuk gejala dan tanda TVD. Pasien yang memiliki gejala dan tanda klinis TVD dilakukan pemeriksaan Ultrasonografi Duplex vascular. HASIL: Seratus tiga pasien tumor ganas ovarium diikutkan dalam analisis. Insideni TVD adalah 16.5 dan 88.2 kejadian TVD terjadi sebelum pembedahan. Tidak ditemukan kejadian TVD selama perawatan pasca operasi dengan rata rata lama perawatan 8.8 hari. Kombinasi beberapa variable menghasilkan model prediksi kejadian TVD pada tumor ganas ovarium yang mencakup metastasis jauh OR 28,99; IK 95 3,83-219,52, IMT ge; 22,7 kg/m2 OR 15,52, IK 95 2,24-107,37 , kadar D-Dimer ge; 1700 mg/ml OR 13,30, IK 95 2.40-73,84 , stadium lanjut OR 6,66; IK 95 1,05-42,27 , histologi epithelial OR 6,5; IK 95 0,34-125,75 , diameter tumor ge; 18,25 cm OR 2,36, IK 95 0,48-11,54 , adanya komorbid OR 2,49, IK 95 0,53-11,66. Skor prediksi kejadian TVD adalah skor 3 untuk metastasis jauh, IMT ge; 22,76 kg/m2, D dimer ge; 1700 mg/dl, skor 2 untuk stadium lanjut, skor 1 untuk komorbid, diameter tumor ge; 18,25 cm, histologi epitelial dan skor 0 jika tidak ditemukan factor risiko atau nilai variable dibawah titik potong. Skor ge; 8 dari 14 adalah skor minimum dengan nilai prediksi TVD yang baik dengan AUC 0,92 IK 95 0,86-0,98, probabilitas 86,46, sensitivitas 64.7, spesifisitas 90.7. KESIMPULAN: Model prediksi kejadian TVD dapat membantu memprediksi pasien tumor ganas ovarium yang berisiko tinggi untuk mengalami TVD sehingga dapat dipertimbangkan pencegahan TVD selektif.

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BACKGROUND: Malignancy increase the risk of venous thromboembolism around 2 7 fold. Its incidence in ovarian malignancy ranged within 5 29 . Various characteristics related to patients age, body mass index, comorbid , tumor stage, tumor diameter, histology, ascites, distant metastasis or treatment length of surgery, bleeding, transfusion were found as predictor of venous thromboembolism. Predictor model of DVT occurrence in ovarian malignant tumor especially in Indonesian population is still limited.

OBJECTIVE: To evaluate the prediction model of deep vein thrombosis DVT in ovarian malignant tumor.

METHOD: This prospective cohort study enrolled 116 patients with suspected ovarian malignant tumor. Suspected risk factors of venous thromboembolism such as age, body mass index BMI , comorbid, pretreatment D dimer, fibrinogen, thrombocyte level, tumor diameter, staging, presence of distant metastasis, ascites, tumor histopathology, length of surgery, intraoperative blood loss and blood transfusion were measured and recorded. Patient who had symptoms and signs of DVT was confirmed with Doppler ultrasonography.

RESULT: Incidence of symptomatic DVT was 16.5 and 88.2 cases occurred before surgery. No case of symptomatic DVT was observed during post operative hospitalization with mean length of stay 8.85 days. Predictor factor of DVT were distant metastasis OR 28,99 95 CI 3,83 219,52, BMI ge 22,7 kg m2 OR 15,52, 95 CI 2,24 107,37 , D Dimer ge 1700 mg ml OR 13,30, 95 CI 2.40 73,84, advanced stage OR 6,66 95 CI 1,05 42,27 , epithelial tumor OR 6,5 95 CI 0,34 125,75, tumor diameter ge 18,25 cm OR 2,36, 95 CI 0,48 11,54, comorbid OR 2,49, 95 CI 0,53 11,66. Prediction score of DVT were score 3 for distant metastasis, BMI ge 22,7 kg m2, D Dimer ge 1700 mg ml, score 2 for advanced stage, score 1 for tumor diameter ge 18,25 cm, comorbid, epithelial tumor and score 0 for the absence of variables or value of variable was less than the cut off. Total score ge 8 of 14 is the least score which has a good predictive value for DVT ocurence with AUC 0.92, 95 CI 0.86 0.92, probability 86,46, sensitivity 64.7, specificity 90.7.

CONCLUSION: Prediction model of DVT may help to predict the patient with malignan ovarian tumor who had high risk of DVT therefore can consider selective DVT prevention."

"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)."

"Latar Belakang: Kanker ovarium menduduki peringkat ke-3 sebagai kanker tersering pada perempuan di Indonesia. Keganasan ovarium dianggap sebagai silent killer karena tidak memiliki gejala yang signifikan pada stadium awal sehingga hampir 50% pasien datang sudah pada stadium lanjut. Oleh karena itu, diperlukan alat skrining di pelayanan primer untuk mendeteksi keganasan ovarium dan salah satu modalitas pemeriksaan adalah ultrasonografi sederhana.Tujuan: Mengetahui nilai diagnostik pemeriksaan ultrasonografi sederhana dalam menilai keganasan tumor ovarium dibandingkan hasil histopatologi pascaoperasi.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor ovarium di polikinik Ginekologi RSCM Jakarta yang dilakukan operasi pada bulan Maret hingga Juli 2015. Sampel penelitian diambil dengan metode consecutive sampling. Analisis menggunakan uji Chi-square dan regresi logistik untuk mencari hubungan antara pola morfologi ultrasonografi dengan hasil histopatologi dimana terdapat hubungan bermakna apabila nilai p<0,05. Selain itu, dibuat model persamaan dari regresi logistik untuk menghitung probabilitasHasil: Terdapat 80 subjek penelitian dimana 58 subjek (72,5%) dengan tumor jinak dan 22 subjek (27,5%) dengan tumor ganas. Hasil ultrasonografi dengan pola morfologi ≥2 menunjukkan hasil ganas pada 53,8% subjek dengan nilai diagnostik sensitivitas 100%, spesifisitas 82,8%, nilai duga positif 68,8%, dan nilai duga negatif 100%. Pola morfologi yang paling berpengaruh terhadap keganasan tumor ovarium adalah permukaan dalam dinding kista ireguler, multilokular, terdapat penonjolan papiler, dan ada bagian padat dalam tumor. Probabilitas subjek mendapat tumor ganas apabila memiliki pola morfologi ≥3 adalah lebih dari 88,9%,Kesimpulan: Pemeriksaan ultrasonografi sederhana dapat digunakan untuk mendeteksi keganasan tumor ovarium.

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Background: Ovarian cancer ranked 3rd most common cancer in Indonesian women. Ovarian malignancy is considered as silent killer because there is no significant symptom in early stage therefore almost 50% patients came in late stage. Thus, screening tool is needed in primary health care to detect ovarian malignancy and one of recommended modality is simple ultrasound examination.

Aim: To know diagnostic values of simple ultrasound examination to detect ovarian malignancy compared with post operative histopathologic findings.

Method: This study used cross-sectional design in Cipto Mangunkusumo Hospital gynecologic outpatients with ovarian tumor undergone operation between March to July 2015. Samples were taken using consecutive sampling. Analysis was done using Chi-square test and logistic regression to find the relationship between ultrasound morphologic patterns with histopathologic findings where there is a significant relationship when p value < 0.05. Furthermore, a model derived from logistic regression was made to calculate the probability having ovarian malignancy.

Result: There were 80 subjects which 58 subjects (72.5%) have benign tumor and 22 subjects (27.5%) have malignant tumor. Ultrasound examination result using ≥2 morphologic patterns gave malignant result in 53.8% subjects with diagnostic values of sensitivity of 100%, specificity 82.8%, positive predictive value of 68.8%, and negative predictive value of 100%. The most important patterns were irreguler internal cyst wall, multilocular, presence of pappilary projection, and presence of solid component. The probability of subject having ovarian malignancy if there were ≥3 morphologic patterns was more than 88.9%.

Conclusion: Simple ultrasound examination can be used to detect ovarian malignancy."

"[Penyakit Arteri Perifer (PAP) merupakan sumbatan aliran darah arteri selain koroner dan intrakranial. PAP dihasilkan dari proses atherosklerosis, emboli, trombus, dan inflamasi yang mengarah ke stenosis arteri. PAP asimptomatik menempati 3-10% populasi dunia, dan meningkat hingga 15-20% pada 70 tahun ke atas. Divisi kami mencatat 18,1-24,7% pasien kaki diabetik dengan PAP mengalami amputasi pada kurun waktu 3 tahun terakhir. Evaluasi ultrasonografi Doppler pada arteri utama ekstremitas bawah diharapkan mampu mendeteksi secara dini apakah pasien akan diamputasi atau tidak baik mayor maupun minor. Metode yang diambil adalah analitik komparatif kategorik independen dengan disain penelitian kohort retrospektif. Selama Januari 2010 hingga Desember 2011 didapatkan 24 pasien yang masuk kriteria inklusi. Arteri yang diperiksa a.femoralis, a.poplitea, a.tibialis posterior, dan a.dorsalis pedis dengan tampilan spektral mulai dari monofasik, bifasik, atau trifasik terutama dengan pelebaran spektral. Ultrasonografi salah satu modalitas ?operator dependent?, untuk mengurangi bias, peneliti menggunakan operator ultrasonografi adalah peneliti sendiri, trainee atau konsultan divisi kami. Hasil didapatkan spektral bifasik hingga monofasik pada a.femoralis 25,0%, a.poplitea 58,3%, a.tibialis posterior 41,6%, a.dorsalis pedis 45,8%, angka amputasi mayor dan minor masing-masing 4%. Perhitungan statistik didapatkan untuk a.femoralis p=0,054 (95% CI), a.poplitea p=0,006 (95% CI), a.tibialis posterior p=0,010 (95% CI), dan a.dorsalis pedis p=0,021 (95% CI). Secara statistik, prediksi amputasi dapat bermakna pada ultrasonografi Doppler pada a.poplitea, a.tibialis posterior, dan a.dorsalis pedis. Dapat ditarik kesimpulan pemeriksaan ultrasonografi Doppler penting dilakukan pada setiap pasien PAP untuk mengevaluasi secara khusus keadaan empat arteri utama ekstremitas bawah pasien dan untuk prediktor amputasi

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Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.;BACKGROUND Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation. METHODS Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division. RESULTS Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI). CONCLUSION Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss., BACKGROUND

Peripheral Arterial Disease (PAD) is an occlusive disease of the blood flow artery beside coronary and intracranial artery. PAD is a result of atherosclerotic process, embolism, thrombus, and inflammation which toward of artery stenosis. Asymptomatic PAD counts 3-10% of worl population, and increasing until 15-20% in patient more than 70 years old. Our division counts 18.1-24.7% of diabetic foot patient with PAD undergoes amputation within this three years. Evaluation of duplex ultrasound in the main artery of lower extremity hopefully can detect whether patient will undergo limb salvage or limb loss, as early as possible, major or minor amputation.

METHODS

Research method is independent category comparative analytic with retrospective cohort design. Within January 2010 to December 2011, we collect 24 patients that rolled on inclusion criteria. We examined femoral, poplitea, posterior tibial, and dorsalis pedis artery, which showed monophasic, biphasic, and triphasic spectrum of duplex imaging of the ultrasound, and all of them has broadening spectrum.Ultrasound is an operator dependent modality, to decrease the bias of this research, operator of the ultrasound is researcher, fellowship doctors and consultants of our division.

RESULTS

Results are 25% in femoral artery, 58.3% in popliteal artery, 41.6% in posterior tibial artery, and 45.8% in dorsalis pedis artery, which counts for biphasic and monophasic spectrum. Amputation rate is 4% for each minor and major amputation. Statistic analysis for correlation of arterial spectrum with amputation are, femoral artery p=0,054 (95% CI), popliteal artery p=0,006 (95% CI), posterior tibial artery p=0,010 (95% CI), and dorsalis pedis artery p=0,021 (95% CI).

CONCLUSION

Based on statistic analysis, amputation can be significant in duplex imaging of popliteal, posterior tibial, and dorsalis pedis artery. Conslusion regards duplex imaging to be performed in four main arteries of lower extremity, to predict limb loss.]"

"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: Tromboemboli vena (TEV) dapat bermanifestasi sebagai trombosis vena dalam (TVD) ataupun emboli paru (EP). EP sebagai komplikasi TVD dapat berakibat fatal. TVD umumnya terjadi disebabkan multipel faktor risiko seperti penyakit penyerta (komorbid), faktor provokasi, gangguan hemostasis dll. Gangguan fungsi hemostasis berupa keadaan protrombotik sudah dimulai dari awal stadium penyakit ginjal kronik (PGK). Menurunnya laju filtrasi glomerulus berkolerasi dengan peningkatan TEV. Mekanisme pasti bagaimana terjadinya TVD pada penderita PGK sampai saat ini masih belum jelas. Tujuan: Untuk mengetahui profil hemostasis dan faktor risiko yang berhubungan dengan TVD pada pasien PGK. Metode : Penelitian potong lintang retospektif dengan memakai data sekunder pada pasien PGK stadium 3-5 yang dirawat inap selama 1.5 tahun antara Oktober 2011- April 2013. Faktor risiko TVD yang diteliti meliputi DM, CHF, stroke iskemik, faktor provokasi, usia lanjut dan penurunan LFG. Analisis bivariat dan multivariat dilakukan dengan regresi logistik untuk mendapatkan faktor risiko yang paling berhubungan dengan terjadinya TVD pada pasien PGK. Adanya perbedaan proporsi pada kedua kelompok dinilai dengan analisis bivariat. Hasil: Proporsi TVD kasus baru yang telah dikonfirmasi dengan USG Doppler ditemukan sebesar 8% (91 dari 1115 pasien). Subyek penelitian sebanyak 160 pasien terdiri atas kelompok TVD 75 orang dan kelompok Non TVD 85 orang, subyek juga terbagi dalam kelompok Dialisis 77 orang dan Non Dialisis 83 orang. Pada pemeriksaan hemostasis ditemukan persentase rasio APTT <0.8 (1.9%), rasio PT <0.8 (0%), INR <0.8 (0%), fibrinogen >400 mg/dl (56.2%) dan D-Dimer >500 μg/l (87.5%) pada keseluruhan pasien PGK. Kadar fibrinogen lebih tinggi pada kelompok TVD daripada Non TVD. Tidak ada perbedaan hemostasis antara kelompok Dialisis dan Non Dialisis. Dari beberapa faktor risiko TVD yang diteliti, DM merupakan faktor risiko yang bermakna sesuai p <0.001, OR 4.5 (95% KI 2.3-8.8). Kesimpulan: Sebagian besar pasien PGK cenderung mengalami hiperkoagulasi. Pasien PGK dengan DM berisiko untuk mengalami TVD. DM bersama faktor risiko lain dapat menjadi predisposisi terjadinya TVD pada PGK.

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Background: Venous thromboembolism (VTE) may manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE). PE as a major complication of DVT and can lead to potentially fatal. DVT can occur as the result of multiple risk factors such as comorbidities, provoked factors, abnormal hemostasis functions and others. Chronic kidney disease (CKD) is typically associated with a prothrombotic tendency in the early stages of the disease. The declining of glomerular filtration rate (GFR) is correlated with increasing of VTE. The exact mechanism of how DVT develops in CKD patients remains unclear.

Aim: To determine the hemostasis profiles and risk factors associated with DVT in CKD patients.

Methods: Retrospective cross sectional study was hold by review the medical records from stage 3-5 CKD patients that hospitalized during 1.5 years (October 2011 - April 2013). Multiple risk factors for TVD such as CHF, stroke ischemic, provoked factors, elderly and decreasing of eGFR were examined. Bivariate and multivariate analysis with logistic regression performed to obtain the most risk factors associated with the occurrence of TVD in CKD patients. The differences of proportion between both groups were assessed by bivariate analysis.

Results: The proportion of first DVT confirmed by doppler ultrasound was 8% (91 of 1115 patients). 160 patients were divided into groups. 75 and 85 patients comprised the group with DVT-Non DVT as well as 77 and 83 patients comprised the group with Dialysis-Non Dialysis. We found the APTT ratio <0.8 (1.9 %), PT ratio <0.8 (0 %), INR <0.8 (0 %), fibrinogen level >400 mg/dl (56.2 %) and DDimer level >500 μg/l (87.5 %) in all CKD patients. The level of fibrinogen was higher when DVT group compared to Non DVT group. There was no significant differences of hemostasis functions between Dialysis and Non Dialysis group. Multivariate analysis demonstrated that diabetes mellitus (p<0.001, OR: 4.5; 95% CI: 2.3 to 8.8) was associated with DVT in CKD patients among all risk factors.

Conclusion: Most CKD patients tend to have hypercoagulation. Diabetes was associated with DVT risk in CKD patients. Diabetes with other risk factors could be as predispotition factors for DVT in CKD in this study."

"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."