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Penggunaan DAPT (Dual Antiplatelet) Pada CVA (Cerebrovascular Accident) Trombosis atau Stroke Iskemik dengan Riwayat PJK (Penyakit Jantung Koroner)
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ABSTRACT
Ischemic stroke is the sudden development of focal neurological deficit due to inadequate blood supply to an area of the brain, which can be thrombotic or embolic. CAD (Coronary Artery Disease) is pathological process characterized by the formation of atherosclerotic plaque followed by rupture, ulceration, or erosion. CAD can take the form of CCS (Chronic Coronary Syndrome). The 2018 AHA/ASA Guidline Antiplatelet Therapy used for ischemic stroke is Aspirin at a dose of 160mg-300mg 1x1. In the 2019 ESC Guidline, CCS patient therapy uses DAPT (Dual antiplatelet). In a 2021 AHA meta-analysis compared with aspirin alone, short-term DAPT within 24 hours after mild-moderate ischemic stroke reduced the risk of recurrent stroke at the expense of a higher risk of major bleeding. Here we present a case of a 76 year old female patient with ischemic stroke and CCS who used DAPT. Complaints of sluggishness, weakness in the left half of the body, acute dysarthria onset on the first day, when waking up. Hemiplegia S 1 week ago onset of waking up and being treated at Mataram Regional Hospital. The patient received the antiplatelet Aspirin 160mg 1x1 a day then switched DAPT (Aspirin 80mg 1x1 and Clopidogrel 75mg 1x1) due to a history of CCS.
Keywords: CVA Thrombosis, Ischemic stroke, Aspilet, Clopidogrel, Coronary Artery Disease
ABSTRAK
Stroke iskemik adalah perkembangan fokal yang tiba-tiba terjadi defisit neurologis akibat suplai oksigen tidak memadai ke suatu area pada otak, dapat bersifat trombotik atau emboli. PJK (Penyakit Jantung Koroner) atau CAD (Coronary Artery Disease) adalah proses patologis ditandai dengan terbentuknya plak aterosklerotik diikuti dengan pecah, ulserasi, atau erosi. PJK dapat berupa penyakit CCS (Chronic Coronary Syndrome). Terapi Antiplatelet Guidline AHA/ASA 2018 yang digunakan pada stroke iskemik adalah Aspirin dosis 160mg-300mg 1x1. Pada Guidline ESC 2019 terapi pasien CCS digunakan DAPT (Dual antiplatelet). Pada meta analisis AHA 2021 dibandingkan dengan aspirin saja, DAPT jangka pendek dalam waktu 24 jam setelah stroke iskemik ringan-sedang mengurangi risiko stroke berulang dengan mengorbankan risiko perdarahan besar yang lebih tinggi. Berikut kami presentasikan sebuah kasus pasien Perempuan 76 tahun dengan Stroke Iskemik dan CCS yang menggunakan DAPT. Keluhann pelo, kelemahan separuh badan kiri, acute disartria onset hari pertama, saat bangun tidur. Hemiplegia S 1 minggu lalu onset bangun tidur di rawat di RSUD Mataram. Pasien menerima antiplatelet Aspirin 160mg 1x1 sehari lalu switch DAPT (Aspirin 80mg 1x1 dan Clopidogrel 75mg 1x1) karena Riwayat CCS.
Kata Kunci: CVA trombosis, Ischemic stroke, Aspilet, Clopidogrel, Penyakit Jantung Koroner.
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Australian Institute Of Health And Welfare. (2023). Heart, Stroke, And Vascular Disease. Https://Www.Aihw.Gov.Au/Reports-Data/Health-Conditions Disability-Deaths/Heart-Stroke-Vascular-Diseases/Overview
Bhatia, K., Jain, V., Aggarwal, D., Vaduganathan, M., Arora, S., Hussain, Z., Uberoi, G., Tafur, A., Zhang, C., Ricciardi, M., & Qamar, A. (2021). Dual Antiplatelet Therapy Versus Aspirin In Patients With Stroke Or Transient Ischemic Attack: Meta-Analysis Of Randomized Controlled Trials. Stroke, 52(6), E217–E223. Https://Doi.Org/10.1161/Strokeaha.120.033033
Bularga, A., Meah, M. N., Doudesis, Di., Shah, A. S. V., Mills, N. L., Newby, D. E., & Lee, K. K. (2021). Duration Of Dual Antiplatelet Therapy And Stability Of Coronary Heart Disease: A 60 000-Patient Meta-Analysis Of Randomised Controlled Trials. Open Heart, 8(2), 1–11. Https://Doi.Org/10.1136/Openhrt-2021-001707
Channing Hui; Prasanna Tadi; Laryssa Patti. (2022). Ischemic Stroke. National Library Of Medicine. Https://Www.Ncbi.Nlm.Nih.Gov/Books/Nbk499997/
Cluxton, R. J. (2006). Book Review: Pharmacotherapy: A Pathophysiologic Approach, 6th Edition. In Annals Of Pharmacotherapy (Vol. 40, Issue 9). Https://Doi.Org/10.1345/Aph.1h160
Diener, H. C., & Hankey, G. J. (2020). Primary And Secondary Prevention Of Ischemic Stroke And Cerebral Hemorrhage: Jacc Focus Seminar. Journal Of The American College Of Cardiology, 75(15), 1804–1818. Https://Doi.Org/10.1016/J.Jacc.2019.12.072
Greving, J. P., Diener, H. C., Reitsma, J. B., Bath, P. M., Csiba, L., Hacke, W., Kappelle, L. J., Koudstaal, P. J., Leys, D., Mas, J. L., Sacco, R. L., & Algra, A. (2019). Antiplatelet Therapy After Noncardioembolic Stroke: An Individual Patient Data Network Meta-Analysis. Stroke, 50(7), 1812–1818. Https://Doi.Org/10.1161/Strokeaha.118.024497
Hao, Q., Tampi, M., O’donnell, M., Foroutan, F., Siemieniuk, R. A. C., & Guyatt, G. (2018). Clopidogrel Plus Aspirin Versus Aspirin Alone For Acute Minor Ischaemic Stroke Or High Risk Transient Ischaemic Attack: Systematic Review And Meta-Analysis. Bmj (Online), 363. Https://Doi.Org/10.1136/Bmj.K5108
Helwig, N. E., Hong, S., & Hsiao-Wecksler, E. T. (2019). Pharmacoterapy Principles & Practice (5th Ed.). Mcgraw-Hill Education.
Herpich, F., & Rincon, F. (2020). Management Of Acute Ischemic Stroke. Critical Care Medicine, 48(11), 1654–1663. Https://Doi.Org/10.1097/Ccm.0000000000004597
Kamarova, M., Baig, S., Patel, H., Monks, K., Wasay, M., Ali, A., Redgrave, J., Majid, A., & Bell, S. M. (2022). Antiplatelet Use In Ischemic Stroke. Annals Of Pharmacotherapy, 56(10), 1159–1173. Https://Doi.Org/10.1177/10600280211073009
Kemenkes Ri. (2019) Pedoman Nasional Pelayanan Kedokteran Tata Laksana Stroke. Keputusan Menteri Kesehatan Republik Indonesia, 2, 1–13.
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Turan, T. N., & Williams, L. S. (2021). 2021 Guideline For The Prevention Of Stroke In Patients With Stroke And Transient Ischemic Attack: A Guideline From The American Heart Association/American Stroke Association. In Stroke (Vol. 52, Issue 7). Https://Doi.Org/10.1161/Str.0000000000000375
Lee, T. L., Chang, Y. M., & Sung, P. S. (2023). Clinical Updates On Antiplatelet Therapy For Secondary Prevention In Acute Ischemic Stroke. Acta Neurologica Taiwanica, 32(3), 138–144.
Lesiak, M., & Komosa, A. (2021). Dual Antiplatelet Therapy For Reduction In Mortality In Patients With Acute And Chronic Coronary Syndromes. Postepy W Kardiologii Interwencyjnej, 17(4), 340–343. Https://Doi.Org/10.5114/Aic.2021.112082
Lin, Y., Cai, Z., Dong, S., Liu, H., Pang, X., Chen, Q., Yuan, J., & Geng, Q. (2022). Comparative Efficacy And Safety Of Antiplatelet Or Anticoagulant Therapy In Patients With Chronic Coronary Syndromes After Percutaneous Coronary Intervention: A Network Meta-Analysis Of Randomized Controlled Trials. Frontiers In Pharmacology, 13(September), 1–11. Https://Doi.Org/10.3389/Fphar.2022.992376
Liu, C., & Ma, L. (2023). Comparison Efficacy And Safety Of Different Antiplatelet Or Anticoagulation Drugs In Chronic Coronary Syndromes Patients: A Bayesian Network Meta-Analysis. Medicine (United States), 102(48), E36429. Https://Doi.Org/10.1097/Md.0000000000036429
Minhas, J. S., Chithiramohan, T., Wang, X., Barnes, S. C., Clough, R. H., Kadicheeni, M., Beishon, L. C., & Robinson, T. (2022). Oral Antiplatelet Therapy For Acute Ischaemic Stroke. Cochrane Database Of Systematic Reviews, 2022(1). Https://Doi.Org/10.1002/14651858.Cd000029.Pub4
Neumann, F. J., Sechtem, U., Banning, A. P., Bonaros, N., Bueno, H., Bugiardini, R., Chieffo, A., Crea, F., Czerny, M., Delgado, V., Dendale, P., Knuuti, J., Wijns, W., Flachskampf, F. A., Gohlke, H., Grove, E. L., James, S., Katritsis, D., Landmesser, U., … Clapp, B. (2020). 2019 Esc Guidelines For The Diagnosis And Management Of Chronic Coronary Syndromes. European Heart Journal, 41(3), 407–477. Https://Doi.Org/10.1093/Eurheartj/Ehz425
Phipps, M. S., & Cronin, C. A. (2020). Management Of Acute Ischemic Stroke. The Bmj, 368. Https://Doi.Org/10.1136/Bmj.L6983
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines For The Early Management Of Patients With Acute Ischemic Stroke: 2019 Update To The 2018 Guidelines For The Early Management Of Acute Ischemic Stroke A Guideline For Healthcare Professionals From The American Heart Association/American Stroke A. In Stroke (Vol. 50, Issue 12). Https://Doi.Org/10.1161/Str.0000000000000211
Ronda Lun, Md1,2; Shan Dhaliwal, Bsc1; Gabriele Zitikyte, Bsc1, 3; Et Al. (2022). Comparison Of Ticagrelor Vs Clopidogrel In Addition To Aspirin In Patients With Minor Ischemic Stroke And Transient Ischemic Attack A Network Meta-Analysis. Jama - Journal Of The American Medical Association. Https://Doi.Org/Doi:10.1001/Jamaneurol.2021.4514
Tremonti, C., & Thieben, M. (2021). Drugs In Secondary Stroke Prevention. Australian Prescriber, 44(3), 85–90. Https://Doi.Org/10.18773/Austprescr.2021.018
Yang, Y., Huang, Z., & Zhang, X. (2021). Efficacy And Safety Of Clopidogrel And/Or Aspirin For Ischemic Stroke/Transient Ischemic Attack An Overview Of Systematic Reviews And Meta-Analysis. Medicine (United States), 100(50), E27804. Https://Doi.Org/10.1097/Md.0000000000027804
Zhu, H., Xu, X., Fang, X., Ying, F., Song, L., Gao, B., Tong, G., Zhou, L., Chen, T., & Huang, J. (2021). Efficacy And Safety Of Long-Term Antithrombotic Strategies In Patients With Chronic Coronary Syndrome: A Network Meta-Analysis Of Randomized Controlled Trials. Journal Of The American Heart Association, 10(6). Https://Doi.Org/10.1161/Jaha.120.019184
DOI: https://doi.org/10.33024/mahesa.v4i12.16289
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