ANALISIS EFEKTIVITAS DAN EFEK SAMPING PENGGUNAAN CLOPIDOGREL TUNGGAL DAN KOMBINASI CLOPIDOGREL- ASPILET PADA PASIEN STROKE ISKEMIK DI RSUP DR.WAHIDIN SUDIROHUSODO MAKASSAR

Authors

  • Nurul Inayah Fakultas Farmasi, Universitas Hasanuddin, Makassar
  • Marianti A. Manggau Fakultas Farmasi, Universitas Hasanuddin, Makassar
  • Yunus Amran Fakultas Kedokteran, Universitas Hasanuddin, Makassar

Abstract

Aspilet dan Clopidogrel merupakan antiplatelet yang dapat digunakan tunggal maupun kombinasi, beberapa penelitian telah dilakukan dengan membandingkan efektivitas keduanya menunjukkan tidak ada perbedaan yang signifikan. Di Indonesia, belum pernah dilakukan penelitian mengenai manfaat dan efek samping penggunaan Clopidogrel tunggal maupun kombinasi Clopidogrel-Aspilet. Tujuan penelitian untuk mengetahui efektivitas penggunaan Clopidogrel tunggal dan kombinasi Clopidogrel-Aspilet untuk mencapai nilai normal Protrombin Time (PT) dan Activated Partial Thromboplastin Time (APTT) serta perbaikan klinis berdasarkan Barthel Index (BI) dan melihat efek samping penggunaan terapi terhadap gastrointestinal. Desain penelitian yang digunakan adalah penelitian observasional prospektif dan retrospektif. Jumlah sampel 26 pasien, terdiri dari penggunaan Clopidogrel tunggal (kelompok I) dan kombinasi Clopidogrel-Aspilet (kelompok II). Hasil pemeriksaan PT sebelum pemberian terapi, pada kelompok I (9,46+0,518) dan kelompok II (9,65+0,688) dengan nilai p=0,545, nilai APTT pada kelompok I (21,30+0,630) dan kelompok II (21,53+1,198), nilai p=0,920. Setelah memperoleh terapi tampak bahwa perubahan nilai PT terhadap kelompok I (11,38+1,120) dan kelompok II (11,00+0,912) memperlihatkan tidak ada perbedaan bermakna diantara keduanya (p=0,396). Demikian juga nilai APTT terhadap kelompok I (24,46+1,853) dan kelompok II (23,61+2,063), nilai (p=0.186). Outcome klinis berdasarkan BI pada kelompok I dan II memberikan efek yang sama dengan nilai p sebelum pemberian 0,685 dan setelah pemberian p=0,297. Berdasarkan kejadian efek samping pada kelompok I sebanyak 3 pasien (23,1%) dan kelompok II sebanyak 10 pasien (76,9%) mengalami nyeri ulu hati, dengan nilai p=0,006. Dari penelitian yang telah dilakukan disimpulkan bahwa, penggunaan terapi Clopidogrel 75 mg tablet tunggal lebih efektif dibandingkan dikombinasi dengan Aspilet 80 mg chewable

References

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JHY, Alger HM, Wong SS, Muntner P. 2017. Heart Disease andStroke Statistics 2017At-a-Glance. American Stroke Association.

Mozzfarian. 2017. Stroke Fact Sheet. American Stroke Association.

Wang, Y., Wang, Y., Zhao, X., Liu, L., Wang, D. Wang, C., et al., Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack. New England Journal of Medicine. 2013;

Woelke BJ, Angell D, Litow K. Clopidogrel alone is safer than clopidogrel and aspirin for secondary prevention of acute ischemic stroke. Wayne State University School of Medicine: Amerika Serikat. 2017;

Siwi H, Titien Dan Dewi Setyaningsing. 2017. The Effectiveness of Clopidogrel as an Antithrombotic Compared To Ticlopidine And Aspirin (Meta-Analysis). Fakultas Farmasi Universitas Sanata Dharma, Kampus Iii Maguwoharjo Depok Sleman : Yogyakarta. doi: http://dx.doi.org/10.24071/jpsc.141565.

Koda – Kimble and young’s. Applied Theraupetic the Clinical Use of Drugs tenth edition, Lippincott Williams & Wilkins, awolterskluwer business two commerce square, 2009.

Palm, F, 2011. . Etiology, Risk Factor and Sex Differences in Ischemic Stroke in the Ludwifshafen Stroke Study, a Populattion-Based Stroke Registry. Germany : Departement of Neurology, Stadisches Klinikum Ludwigshafen.

Banerjee, Sunip. 2012. Common Drug Interactions in Cardiology Prescription. Medicine Update. Vol. 22, Kolkata.

Boehm.A.K, Esenwa.C and Elkind.M.S.V. 2017. Stroke Risk Factors, Genetics, and Prevention. Circulation Research is published by the American Heart Association.

Hindy.G, Engstrom.G, Larsson.SC, Traylor.M, Markus HS, Melander O. 2018. Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes A Mendelian Randomization Study. Departement of Clinical Sciences in Malmo, Lund University.

Secades J.J; Sabin J.A; Castillo J; Tejedor E.D; Vila E.M; Rios J; Oudovenko N. 2016. Citicoline for Acute Ischemic Stroke: A Systematic Review and Formal Meta-Analysis of Randomized, Double-Blind, and Placebo-Controlled Trials. National Stroke Association. Published by Elsevier. DOI:10.1016/j.jstrokecerebrovasdis.2016.04.010.

Weber, M.A., Ernesto L. Schiffrin, William B. White, Samuel Mann, Lars H. Lindholm, John G. Kenerson, John M. Flack, Barry L. Carter, Barry J. Materson, C. Venkata S. Ram, Debbie L. Cohen, Jean-Claude Cadet, Roger R. Jean-Charles, Sandra Taler, David Kountz, Raymond R. Townsend, John Chalmers, Agustin J. Ramirez, George L. Bakris, Jiguang Wang, Aletta E. Schutte, John D. Bisognano, Rhian M. Touyz, Dominic Sica, dan Stephen B. Harrap. Clinical Practice Guidelines for the Management of Hypertension in the Community: A Statement by the American Society of Hypertension and The International Society of Hypertension. The Journal of Clinical Hypertension. Vol 16 (1), 2014; hal. 14-26.

Setyopranoto I; Wijono D; Pudjiastono E.S; Wahyuningrum S; Indradewi A.S; Raymond R dan Tjandrawinata. Uji Klinik Buta Ganda Perbedaan Profil Perdarahan dan Outcome Klinis Pasien Stroke Iskemik dengan Pemberian DLBS1033, Aspirin, dan Clopidogrel. Bagian Neurologi Fakultas Kedokteran Universitas Gadjah Mada/SMF Saraf RSUP Dr.Sardjito Yogyakarta : Indonesia; 2013.

Cryer B, Mahaffey K.W. 2014. Gastrointestinal Ulcers, Role of Aspirin, And Clinical Outcomes: Pathobiology, Diagnosis, And Treatment. University of Texas Southwestern Medical School, Dallas, TX, Department of Medicine, Stanford University, Stanford, CA, USA.

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Published

2019-03-18

Issue

Vol. 22 No. 3 (2018): MFF

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Articles

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