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March 24, 2023
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June 28, 2024
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Abstract

Sindrom koroner akut (SKA) merupakan penyebab kematian nomor 1 di dunia dan nomor 2 di Indonesia setelah strok. Pengobatan yang tepat dapat menurunkan resiko terjadinya kematian akibat SKA. Antiplatelet, antikoagulan atau fibrinolitik merupakan obat yang digunakan untuk penatalaksanaan SKA. Akan tetapi, sampai saat ini gambaran penggunaan obat pada pasien SKA di Indonesia yang meliputi SKA-NSTEMI dan SKA-STEMI masih terbatas. Selain itu, profil dan penggunaan obat SKA di kota Tasikmalaya masih belum diketahui. Tujuan penelitian ini adalah untuk mengetahui gambaran pasien SKA dan pengobatannya. Penelitian ini merupakan penelitian observasional retrospektif terhadap data rekam medis pasien pada Januari 2020- Desember 2020. Pasien yang masuk kedalam kriteria penelitian berjumlah 78 pasien. Hasil studi menunjukkan bahwa kejadian SKA-STEMI lebih banyak dibandingkan SKA-NSTEMI (RR 4,0986, CI 95% 2.2296-7.5345, p 0,0001), dan banyak terjadi pada usia 40-60 tahun dengan jenis kelamin laki-laki. Gastroesophageal reflux disease (GERD), diabetes melitus dan hipertensi merupakan komorbid terbanyak pada pasien SKA-STEMI, sedangkan hipertensi dan dispepsia merupakan komorbid terbanyak pasien SKA-NSTEMI. Hasil uji hubungan chi square menunjukkan tidak terdapat perbedaan antara jenis SKA dengan usia, jenis kelamin dan komorbid (p>0,05). Pada profil penggunaan obat, antiplatelet meliputi aspirin dan clopidogrel digunakan pada seluruh pasien SKA, sedangkan antikoagulan fondaparinux lebih banyak digunakan dibandingkan dengan enoxaparin (55 vs 23). SKA-STEMI mendominasi dibandingkan SKA-NSTEMI dengan pengobatan yang digunakan adalah aspirin, clopidogrel, fondaparinux, atau enoxaparin, selain itu usia, jenis kelamin dan komorbid tidak berhubungan dengan jenis SKA.

Keywords

Antiplatelet Antikoagulan SKA-STEMI SKA-NSTEMI Sindrom Koroner Akut.

Article Details

Author Biography

Yedy Purwandi Sukmawan, University of Bakti Tunas Husada, Department of Pharmacology and Clinical Pharmacy

Department of Pharmacology and Clinical Pharmacy, Interested Area of Research Cardiovascular, Endocrine and Pain

References

  1. Amsterdam, E.A., Wenger, N.K., Brindis, R.G., Casey, D.E., Ganiats, T.G., Holmes, D.R., Jaffe, A.S., Jneid, H., Kelly, R.F., Kontos, M.C., Levine, G.N., Liebson, P.R., Mukherjee, D., Peterson, E.D., Sabatine, M.S., Smalling, R.W., dan Zieman, S.J, 2014, AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol, 64(24), e139-e228.
  2. Antman, E.M., Anbe, D.T., Armstrong, P.W., Bates, E.R., Green, L.A., Hand, M., Hochman, J.S., Krumholz, H.M., Kushner, F.G., Lamas, G.A., Mullany, C.J., Ornato, J.P., Pearle, D.L., Sloan, M.A., dan Smith, S.C, Jr, 2004, American College of Cardiology; American Heart Association; Canadian Cardiovascular Society. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction), J Am Coll Cardiol, 44(3), 671-719.
  3. Capewell, S., Ford, E.S., Croft, J.B., Critchley, J.A., Greenlund, K.J., dan Labarthe, D.R, 2010, Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America, Bull World Health Organ, 88(2), 120-130.
  4. Chen, C.H., Lin, C.L., dan Kao, C.H, 2016, Association between gastroesophageal reflux disease and coronary heart disease: A nationwide population-based analysis. Medicine (Baltimore), 95(27), e4089.
  5. Downer, B., Estus, S., Katsumata, Y., dan Fardo, D.W, 2014, Longitudinal trajectories of cholesterol from midlife through late life according to apolipoprotein E allele status. International journal of environmental research and public health, 11(10), 10663–10693.
  6. Eisa, M., Sandhu, A., Prakash, R., Ganocy, S.J., dan Fass, R, 2020, The Risk of Acute Myocardial Infarction in Patients With Gastroesophageal Reflux Disease. J Neurogastroenterol Motil, 26(4), 471-476.
  7. Fox, K.A., Bassand, J.P., Mehta, S.R., Wallentin, L., Theroux, P., Piegas, L.S., Valentin, V., Moccetti, T., Chrolavicius, S., Afzal, R., dan Yusuf, S, 2007, OASIS 5 Investigators Influence of renal function on the efficacy and safety of fondaparinux relative to enoxaparin in non ST-segment elevation acute coronary syndromes, Ann Intern Med, 147(5), 304-310.
  8. Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., Hindricks, G., Kastrati, A., Lenzen, M. J., Prescott, E., Roffi, M., Valgimigli, M., Varenhorst, C., Vranckx, P., Widimský, P., dan ESC Scientific Document Group, 2018, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, 39(2), 119–177.
  9. Irmalita, J., Andrianto, D.A., Setianto, B.Y., Tobing, D.P.L., Firman, D., dan Firdaus I, 2015, Pedoman tatalaksana Sindrom Koroner Akut, PERKI, 3, 1-88.
  10. Jolly, S.S., Faxon, D.P., Fox, K.A., Afzal, R., Boden, W.E., Widimsky, P., Steg, P.G., Valentin, V., Budaj, A., Granger, C.B., Joyner, C.D., Chrolavicius, S., Yusuf, S., dan Mehta, S.R, 2009, Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors or thienopyridines: results from the OASIS 5 (Fifth Organization to Assess Strategies in Ischemic Syndromes) trial, J Am Coll Cardiol, 54(5), 468-476.
  11. Joyner, C.D., Peters, R.J., Afzal, R., Chrolavicius, S., Mehta, S.R, Fox, K.A., Granger, C.B., Franzosi, M.G., Flather, M., Budaj, A., Bassand, J.P., dan Yusuf, S, 2009, Fondaparinux compared to enoxaparin in patients with acute coronary syndromes without ST-segment elevation: outcomes and treatment effect across different levels of risk, Am Heart J, 157(3), 502-508.
  12. Keller, P.F., Carballo, D., dan Roffi, M, 2010, Diabetes and acute coronary syndrome, Minerva Med, 101(2), 81-104.
  13. Kemenkes RI. 2017. Penyakit Jantung Penyebab Kematian Tertinggi, Kemenkes Ingatkan CERDIK, diperoleh melalui situs https://www.kemkes.go.id/article/view/17073100005/penyakit-jantung-penyebab-kematian-tertinggi-kemenkes-ingatkan-cerdik-.html#:~:text=PENYAKIT%20JANTUNG%20PENYEBAB%20KEMATIAN%20TERTINGGI%2C%20KEMENKES%20INGATKAN%20CERDIK&text=Survei%20Sample%20Regristration%20System%20(SRS,yakni%20sebesar%2012%2C9%25. Diunduh pada tanggal 25 April 2021).
  14. Kossovsky, M., Keller, P.F., Mach, F., dan Gaspoz, J.M, 2012, Fondaparinux versus enoxaprin in the management of acute coronary syndromes in Switzerland: A cost comparison analysis, Swiss Med Wkly, 142, w13536.
  15. Manisty, C., Hughes-Roberts, Y., dan Kaddoura, S, 2009, Cardiac manifestations and sequelae of gastrointestinal disorders, Br J Cardiol, 16, 175–180.
  16. Mehta, S.R., Granger, C.B., Eikelboom, J.W., Bassand, J.P., Wallentin, L., Faxon, D.P., Peters, R.J., Budaj, A., Afzal, R., Chrolavicius, S., Fox, K.A., Yusuf, S, 2007, Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: results from the OASIS-5 trial, J Am Coll Cardiol, 50(18), 1742-1751.
  17. Open Data Kota Tasikmalaya, diperoleh melalui situs internet https://data.tasikmalayakota.go.id/. Diunduh pada tanggal 20 Maret 2022.
  18. Permsuwan, U., Chaiyakunapruk, N., Nathisuwan, S., dan Sukonthasarn, A, 2015, Cost-Effectiveness Analysis of Fondaparinux vs Enoxaparin in Non-ST Elevation Acute Coronary Syndrome in Thailand. Heart Lung Circ, 24(9), 860-868.
  19. Rashid, M.H., Yaseen, G., Ghaffar, U., Khan, A.A., Kabir, A., Aisha, A., dan Komel, A, 2020, Prevalence of Acute Coronary Syndrome and Various Risk Factors in Acute Strok Patients. Cureus, 12(8), e9552.
  20. Ren, L., Ye, H., Wang, P., Cui, Y., Cao, S., dan Lv, S, 2014, Comparison of long-term mortality of acute ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients after percutaneous coronary intervention. International journal of clinical and experimental medicine, 7(12), 5588–5592.
  21. Sculpher, M.J., Lozano-Ortega, G., Sambrook, J., Palmer, S., Ormanidhi, O., Bakhai, A., Flather, M., Steg, P.G., Mehta, S.R., Weintraub, W, 2009, Fondaparinux versus Enoxaparin in non-ST-elevation acute coronary syndromes: short-term cost and long-term cost-effectiveness using data from the Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators (OASIS-5) trial, Am Heart J, 157(5), 845-852.
  22. Soeiro, A.M., Silva, P.G., Roque, E.A., Bossa, A.S., César, M.C., Simões, S.A., Okada, M.Y., Leal, T.C., Pedroti, F.C., dan Oliveira, M.T. Jr, 2016, Fondaparinux versus Enoxaparin - Which is the Best Anticoagulant for Acute Coronary Syndrome? - Brazilian Registry Data, Arq Bras Cardiol, 2016, 107(3), 239-244.
  23. Sukmawan, Y.P., Idacahyati, K., dan Firdaus, R.F, 2020, Enoxaparin vs Fondaparinux in CK-MB Reduction. Jurnal Farmasi Indonesia, 17(2), 78–82.
  24. Ten Haaf, M.E., Bax, M., Ten Berg, J.M., Brouwer, J., Van’t Hof, A.W., Van der Schaaf, R.J., Stella, P.R., Tjon Joe Gin, R.M., Tonino, P.A., de Vries, A.G., Zijlstra, F., Boersma, E., dan Appelman, Y, 2019, Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands, Netherlands Heart Journal, 27(5), 263–271.
  25. Terres, R.J.A., Lozano-Ortega, G., Kendall, R., dan Sculpher, M.J, 2015, Cost-effectiveness of fondaparinux versus enoxaparin in non-ST-elevation acute coronary syndrome in Canada (OASIS-5), BMC Cardiovasc Disord, 15, 180.
  26. World Health Organizations (WHO). The top 10 causes of death, diperoleh melalui situs https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of death#:~:text=The%20world's%20biggest%20killer%20is,8.9%20million%20deaths%20in%202019. Diunduh pada tanggal 15 April 2021.
  27. Yi, S.W., Yi, J.J., dan Ohrr, H, 2019, Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults, Sci Rep, 9(1), 1596.
  28. Yusuf, S., Mehta, S. R., Chrolavicius, S., Afzal, R., Pogue, J., Granger, C.B., Budaj, A., Peters, R.J., Bassand, J.P., Wallentin, L., Joyner, C., Fox, K.A, 2006, Comparison of fondaparinux and enoxaparin in acute coronary syndromes, N Engl J Med, 354(14), 1464-1476.
  29. Zhao, X., Yang, X.X., Ji, S.Z., Wang, X.Z., Wang, L., Gu, C.H., Ren, L.L., dan Han, Y.L, 2016, Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban, Mil Med Res, 3, 13.
  30. Zhao, X., Yang, X.X., Ji, S.Z., Wang, X.Z., Wang, L., Gu, C.H., Ren, L.L., dan Han, Y.L, 2016, Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban, Mil Med Res, 3, 13.