Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Kasus trombosis vena dalam (TVD) pasca operasi di Indonesia dianggap jarang, demikian pula dengan trombofilia. Oleh karena itu, penulis berpendapat bahwa diperlukan penelitian untuk mendapat angka kejadian TVD pasca operasi ortopedi risiko tinggi, dan profil trombofilia pada kasus TVD dan non-TVD di Indonesia. Penelitian cross sectional ini dilakukan pada 20 pasien yang menjalani operasi daerah panggul (total hip replacement dan fiksasi fraktur femur proksimal) dan daerah lutut (fiksasi femur distal dan total knee replacement). Pada tiap pasien dilakukan pemeriksaan protein C, protein S, antitrombin III, dan fibrinogen pada hari kelima pasca operasi, kemudian pada periode antara hari kesepuluh dan keduapuluhsatu pasca operasi dilakukan pemeriksaan USG kompresi/Doppler vena. Bila hasil USG-nya menunjukkan adanya TVD, maka dikonfirmasi dengan venografi. TVD ditemukan pada lima pasien (25%). Defisiensi protein C (P= 0,46), protein S (P= 0,81), antitrombin III (P= 0,46), dan hiperfibrinogenemia (P= 0,0547) tidak berkorelasi dengan TVD pasca operasi. Namun demikian, hiperfibrinogenemia merupakan faktor risiko TVD pasca operasi (attributable risk= 1). Faktor penyerta lain seperti diabetes mellitus (P= 1,0), obesitas (P= 0,28), hipertensi (P= 1,0), hipertrigliseridemia, dan hiperkolesterolemia tidak berkorelasi dengan TVD pasca operasi. Penelitian ini menunjukkan adanya kasus TVD pasca operasi di Indonesia. TVD tidak berkorelasi dengan defisiensi protein S, protein C, dan antitrombin III. (Med J Indones 2004; 13: 24-30).

---

Post operative DVT is believed to be rare in Indonesia, and so is trombophilia. It is necessary to know the incidence of postoperative DVT in Indonesia and thrombophlia profile (protein C, S, AT III deficiency and hyperfibrinogenemia) in DVT and non DVT patient who underwent orthopedic surgery involving the hip and knee (high risk surgery). A cross sectional study was conducted in 20 patients who underwent surgery involving the hip (total hip replacement and fixation of proximal femoral fracture) and knee (total knee replacement and fixation of distal femoral fracture). Protein C, protein S, antithrombin III, and fibrinogen were examined in day 5 post operative, as well as with compression/Doppler USG between day 10 to 21 post operative, and confirmed by venography if USG findings was positive. Post operative DVT were found in 5 of 20 patients (25%). Deficiency of protein C (P= 0.46) protein S (P= 0.81), antithrombin III (P= 0.46), and hyperfibrinogenemia (P= 0.0547) did not correlate to post operative DVT. However, hyperfibrinogenemia was found to be a risk factor to post operative DVT (attributable risk= 1). Other confounding factor such as diabetes mellitus (P= 1.0), obesity (P= 0.28), hypertention (P= 1.0), hypertrigliseridemia, and hypercholesterolemia did not correlate to post operative DVT. The study suggested the existence of postoperative DVT cases in Indonesia. Hyperfibrinogenemia is a risk factor to promote post operative DVT. Deep vein thrombosis did not correlate to protein S, protein C, and antithrombin III deficiency. (Med J Indones 2004; 13: 24-30).

Abstrak :
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.  ......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.