Presentasi Trombosis Vena Dan Arteri PDF

TROMBOSIS VENA DAN ARTERI LINDA EFANITA Bagian Ilmu Penyakit Dalam Rumah Sakit Achmad Mochtar Bukittinggi ▶ Trombosis dapat terjadi di vena atau sirkulasi arteri ▶ Hasil interaksi kompleks antara protein koagulasi, trombosit, dan dinding pembuluh darah American Heart Association 7,500,00...

TROMBOSIS VENA DAN ARTERI LINDA EFANITA Bagian Ilmu Penyakit Dalam Rumah Sakit Achmad Mochtar Bukittinggi ▶ Trombosis dapat terjadi di vena atau sirkulasi arteri ▶ Hasil interaksi kompleks antara protein koagulasi, trombosit, dan dinding pembuluh darah American Heart Association 7,500,000 US MCI dan 4,600,000 menderita stroke. Trombosis Vena Dalam dan Emboli paru : 300,000 dan 600,000 (dirawat) 100,000 kematian per tahun JENIS VENA ▶ Vena superficial adalah vena subcutan dan vena facia otot, ▶ Vena dalam (deep vein) adalah vena intra dan intermuscular, dan ▶ Vena komunikan adalah vena yang menghubungkan vena dalam dengan vena superficial. Blood Vessels. A.) The wall of an artery. B.) The wall of a vein  TROMBOSIS ▶ Masa abnormal dari konstituen darah melalui proses koagulasi intraluminar sistem vaskular semasa hidup. ▶ Trombosis vena adalah trombosis di dalam vena ▶ Penyakit vena periver tersering yang menyebabkan pasien ke dokter adalah: ▶ Trombosis vena dalam (Deep Vein Thrombosis/DVT), ▶ Tromboflebitis, ▶ Post Thrombotic Syndrome (PTS) akibat insufisiensi katup vena dalam kronik berupa: ▶ pigmentasi stasis dan/atau ▶ dermatitis stasis dan/atau ▶ ulkus stasis. INCIDENCE OF VTE: THE THIRD MOST COMMON VASCULAR DISEASE Annual incidence (US data) Deep vein Pulmonary thrombosis embolism (PE) with (DVT) only or without DVT , fibrin, Red thrombosis : eritrosit >> eritrosit Keterlibatan Arteri korener, aorta, arteri carotis, Vena femoral, vena poplitea, pembuluh darah arteri cerebral, arteri femoral vena iliaca, vena ektrmitas bawah GEJALA KLINIS ▶ Gejala klinis DVT tergantung luasnya keterlibatan vena, ▶ dapat asimptomatik atau ▶ kombinasi dari: ▶ pembengkakan extremitas (tungkai/lengan) mulai dari distal, ▶ otot kaku (tidak lunak), ▶ nyeri otot terutama pada berdiri dan berjalan, ▶ pitting edema tetapi hangat, ▶ kulit kebiruan (cyanosis), ▶ vena superficial prominent akibat dilatasi vena kolateral superfisial GEJALA KLINIS ▶ Gejala klinis thrombosis arteri ▶ Gejala PJK : angina, aritmia ▶ Gejala Peripheral Arterial Disease (PAD) : gangrene ▶ Gejala Stroke  GEJALA KLINIS ▶ Cold arm or leg ▶ Decreased or no pulse in an arm or leg ▶ Fingers or hands feel cool ▶ Lack of movement in the arm or leg ▶ Muscle pain in the affected area ▶ Muscle spasm in the affected area ▶ Numbness and tingling in the arm or leg ▶ Pale color of the arm or leg (pallor) ▶ Weakness of an arm or leg PRESENTASI KLASIK LIMB ISCHEMIA "SIX PS ▶ Pallor ▶ Pain ▶ Paresthesia ▶ Paralysis ▶ Pulselessness ▶ Poikilothermia  GEJALA LEBIH LANJUT ▶ Blisters of the skin fed by the affected artery ▶ Shedding (sloughing) of skin ▶ Skin erosion (ulcer) ▶ Tissue death (necrosis; skin is dark and damaged)  DIAGNOSIS TROMBOSIS VENA ▶ Flebografi merupakan gold standard diagnostik trombosis, ▶ Ultrasonografi color Doppler kompresi merupakan diagnostik non invasive terbaik, ▶ Occlusive impedance plethysmography, D-Dimer juga digunakan dalam diagnostik. ▶ Magnetic resonant Angiography (MRA) EVALUASI DIAGNOSTIK TROMBOSI ARTERI ▶ Non-invasive: ▶ Doppler ultra sound ▶ Gold Standard : Angiografi dengan kontras  DIAGNOSTIC TEST THROMBOSIS Likelihood Ratio Sensitivity Specificity positive (LR+) Occlusive impedance plethysmography 88% (86-90%) 95% (94-95%) 17.60 125 I-Fibrinogen Leg Scanning 94% 91% 10.44 Doppler ultrasound 88% (85-92%) 88% (86-91%) 7.33 Duplex USG 95% (89-98%) 93% (87-97%) 13.57 Conventional USG 95% (93-97%) 98% (96-99%) 47.50 Color doppler USG 97% (95-99%) 98% (96-99%) 48.50 Compression color doppler USG 97% 99% 97.00 Gold standard diagnostic by Phlebography CLINICAL DIAGNOSTICS DECISION RULE Suspected DVT Compression color doppler USG Positive Negative Clinical probability Low Moderat High DV e T D-Dime r CCDU at day 7 Negative Positive Negative Positive No DVT DV T  STANDARDIZED CLINICAL DIAGNOSTICS DECISION MODEL FOR SUSPECTED DVT (Wells et al. Lancet 1995; 354: 1326) Clinical probability parameter Scor Active cancer (ongoing or within previous 6 months chemotherapy) e 1 Paralysis, paresis or recent plaster immobilization of the lower 1 extremities Bedridden for more than 3 days or major surgery within 4 weeks 1 Entire leg swollen 1 Calf swelling of more than 3 cm when compared with the 1 asymptomatic leg (measured 10 cm below the tibial tuberosity) Pitting edema greater in the symptomatic leg 1 Collateral nonvaricose superficial veins 1 Localized tenderness along distribution of the deep vein system 1 Alternative diagnosis as or more likely than DVT -2 0 = Low probability, 1 or 2 = Moderate probability, 3 or more = High probability CLINICAL DIAGNOSTICS DECISION RULE Suspected DVT Compression color doppler USG Positive Negative Clinical probability Low Moderat High DV e T D-Dime r CCDU at day 7 Negative Positive Negative Positive No DVT DV T COMPLICATION OF VTE DVT Thromboembolism Not healing Pulmonary embolism Venous valve Ischemic ulcer incompetence Recurrent DVT  PENGOBATAN ▶ Modalitas pengobatan trombosis vena; ▶ Thrombolyses, ▶ Thrombectomy, ▶ Anticoagulants, ▶ Intermittent Pneumatic Compression, ▶ Gradually compression stocking, ▶ Percutaneous Valvuloplasty BVV*) (success rate 70%). ▶ Anticoagulant are the main therapy for the treatment in Venous thrombosis and thromboembolism Thank you