Deep Vein Thrombosis (DVT) Pasca Cedera Otak Traumatik Berat

Nency Martaria, Iwan Fuadi, Sudadi Sudadi

Abstract


Cedera otak traumatik(COT) adalah penyebab utama kematian dan disabilitas. Deep vein thrombosis (DVT) adalah salah satu risiko tinggi dari COT. Faktor risiko DVT lain yang umum ditemukan pada pasien COTadalah paralisis, imobilisasi, dan cedera ortopedi. Deep vein thrombosis diduga terkait gangguan koagulasi yang sering ditemukan pada COT, terutama pada COT berat. Deep vein thrombosis dapat menyebabkan pulmonary embolism (PE) yang merupakan salah satu penyebab kematian lambat terbanyak pada pasien trauma. Diagnosis DVT didapatkan melalui stratifikasi risiko, pemeriksaan fisik, dan pemeriksaan penunjang yang mencakup pemeriksaan d-dimer, ultrasonografi, dan penunjang lain seperti spiral computed tomography venography. Tata laksana DVT pada pasien COT mencakup pemberian antikoagulan intravena yang dilanjutkan oral jangka panjang,stoking kompresi, dan pemasangan vena cava filter (VCF). Pada pasien COT, adanya risiko perdarahan intrakranial umumnya menimbulkan keraguan pada klinisi terkait inisiasi profilaksis farmakologis dengan antikoagulan. Profilaksis nonfarmakologis mencakup penggunaan graduated compression stocking (GCS), alat kompresi pneumatik (pneumatic compression devices/PCD), A-V foot pump, dan vena cava filter (VCF). Beberapa studi terkini menyarankan pemasangan PCD pada semua pasien COT pada awal perawatan selama tidak ditemukan kontraindikasi. Pemeriksaan CT selanjutnya dilakukan setelah 24 jam. Penemuan hasil yang stabil pada CT, profilaksis farmakologis dapat dimulai dalam 24-48 jam setelah CT. Selama pemberian antikoagulan, CT serial dapat dilakukan untuk memantau progresi perdarahan.

Deep Vein Thrombosis (DVT) after Severe Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is a risk factor for deep vein thrombosis (DVT). Beside the common risk factors of DVT among TBI patients, this is associated with coagulopathycommonly foundin TBI, especially in severe TBI.Diagnosis and treatment of DVT are also crucial to prevent mortality. Deep vein thrombosis could be diagnosed through risk stratification, physical examination, and d-dimer as well as ultrasonography examination. Treatment includes intravena anticoagulant continue with longterm oral, stocking compression and the use of vein cava filter (VCF). Deep vein thrombosis could cause pulmonary embolism (PE), a common cause of late mortality in trauma patients. Deep vein thrombosis could be prevented pharmacologically (with anticoagulant) and nonpharmacologically. However, in TBI patients, the risk of intracranial hemorrhage usually considered an initiation of pharmacological prophylaxis. Nonpharmacological prophylaxisincludes graduated compression stocking (GCS), pneumatic compression devices (PCD), A-V foot pump, and vena cava filter (VCF). Latest studes suggest the use of PCD for all TBI patients without contraindication since administration. Computed tomography should be performed within 24 hours and if the resultis stable, pharmacological prophylaxis should be initiated within 24-48 hours.


Keywords


cedera otak traumatik; deep vein thrombosis; traumatic brain injury; deep vein thrombosis

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DOI: https://doi.org/10.24244/jni.v8i3.236

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DOI:  https://doi.org/10.24244/jni 

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