Perdarahan Gastrointestinal pada Stroke Iskemik Akut: Sebuah Tinjauan Pustaka
Abstract
Perdarahan gastrointestinal pada stroke iskemik akut disebabkan oleh proses neuroinflamasi pada sel otak yang mengalami iskemik. Edema otak yang terjadi pada pasien stroke iskemik akut mempengaruhi hipotalamus dan batang otak. Keterlibatan nukleus vagal pada batang otak menyebabkan peningkatan stimulasi dari vagus serta berkurangnya inhibisi vagus. Proses neuroinflamasi tersebut mempengaruhi sistem saraf parasimpatis menyebabkan hiperaktivitas vagal sehingga terjadi peningkatan pelepasan gastrin yang meningkatkan produksi asam lambung. Perdarahan gastrointestinal pada pasien stroke iskemik akut mengakibatkan penghentian atau penundaan terapi antiplatelet atau antikoagulan sehingga terjadi keadaan prokoagulasi, menyebabkan lebih mudah terjadi trombosis sehingga meningkatkan risiko stroke ulang dan luaran klinis yang buruk. Beberapa penelitian perdarahan gastrointestinal pada pasien stroke iskemik akut mempunyai prognosis yang kurang baik terhadap luaran. Luaran tersebut antara lain perburukan defisit neurologis, kematian di rumah sakit, dan memperpanjang lama perawatan.
Gastrointestinal Bleeding in Acute Ischemic Stroke: A Literature Review
Abstract
Gastrointestinal bleeding in acute ischemic stroke is caused by the process of neuroinflamation in ischemic brain cells. Brain edema that occurs in acute ischemic stroke patients affects the hypothalamus and brainstem. Involvement of the vagal nucleus in the brainstem results in increased stimulation of the vagus and reduced inhibition of the vagus. The neuroinflamation process affects the parasympathetic nervous system causing vagal hyperactivity resulting in an increase in gastrin release which increases gastric acid production. Gastrointestinal bleeding in patients with acute ischemic stroke results in the cessation or delay of antiplatelet or anticoagulant therapy, resulting in a procoagulatory state, making thrombosis easier, thereby increasing the risk of repeated strokes and poor clinical outcomes. Several studies of gastrointestinal bleeding in patients with acute ischemic stroke have a poor prognosis for outcomes. These outcomes include worsening neurological deficits, hospital deaths, and prolonged treatment.
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DOI: https://doi.org/10.24244/jni.v9i3.263
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