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All Journal Jurnal Kedokteran Diponegoro Medica Hospitalia
Pipin Ardhianto
Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, Diponegoro University, Semarang
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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TIME IN THERAPEUTIC RANGE (TTR) IN ATRIAL FIBRILLATION WITH WARFARIN THERAPY IN SEMARANG, INDONESIA Della Dafina Sekarsari; Pipin Ardhianto; Erwin Kresnoadi; Mochamad Ali Sobirin
JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL) Vol 10, No 5 (2021): JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL)
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dmj.v10i5.30046

Abstract

Background: Atrial fibrillation is one of the factors forming thromboembolism. The thromboembolism can be prevented with warfarin. A side effect of warfarin is increasing the occurrence of bleeding, these therapy requires an evaluation of its usage. These evaluations can be seen in the Time in Therapeutic Range (TTR) patients. TTR is the duration in which the International Normalized Ratio (INR) patients in referral value are 2.0-3.0. TTR > 70% can prevent bleeding on FA patients with warfarin therapy.Aim: To determine TTR in patients receiving warfarin with atrial fibrillation.Methods: This study was descriptive with a cross-sectional design for six months at Dr. Kariadi Hospital Semarang. TTR was calculated using Rosendaal's Methods after collecting three INRs and patients' demographics.Results: Total subject was 111 patients with an average age of 52,63 and the TTR average is 53,75. TTR in this study was divided into two groups, that groups were poor TTR (TTR < 70%) with 82 patients (73.88%) and good TTR (≥70%) with 29 patients (26.12%).Conclusions: The average TTR in FA patients with warfarin therapy was 53,75%. 
External Validation of Major Adverse Cardiovascular Events’ Predictors in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Robert Adrianto Raharjo; Susi Herminingsih; Pipin Ardhianto; Yan Herry
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 2 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (602.671 KB) | DOI: 10.36408/mhjcm.v8i2.569

Abstract

BACKGROUND: KARIADI risk score is a 0-to-9 point system based on Killip class, final TIMI flow, total ischemic time, creatinine level, blood glucose, systolic blood pressure, and age. This score was developed to predict the risk of in-hospital major adverse cardiovascular events (MACE) (a composite of death, stroke, urgent revascularization, cardiogenic shock, acute pulmonary edema, or arrhythmia) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI), but its performance has never been validated externally. OBJECTIVE: To perform external validation on KARIADI risk score. METHOD: This study was a prospective cohort study on 109 STEMI patients undergoing PPCI in Dr. Kariadi General Hospital during January-November 2020. Each sample underwent KARIADI risk score assessment and follow-up for in-hospital MACE. The risk score validation was performed by assessing calibration [measured with calibration-in-the-large (alpha), calibration slope (beta), and calibration plot] and discrimination performance [measured with c-statistic and receiver operating characteristic curve). RESULT: Eighteen patients (16.5%) had MACE. KARIADI risk score demonstrated unsuitable calibration (alpha -0.39, beta 0.71, unfit calibration plot) and moderate discrimination performance (c-statistic 0.75, 95% CI 0.62-0.87). CONCLUSION: KARIADI risk score is not valid in predicting in-hospital MACE in patients with STEMI undergoing PPCI. Keywords: ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, KARIADI risk score, external validation
Aspirasi Trombus Selektif Memperbaiki Aliran Koroner dan Mengurangi Tingkat Badai Trombus pada Pasien Sindroma Koroner Akut Dengan Elevasi Segmen ST yang dilakukan Intervensi Koroner Perkutan Primer Liborius Bramantyo; Udin Bahrudin; Pipin Ardhianto; Ilham Uddin; Sodiqur Rifqi
Medica Hospitalia : Journal of Clinical Medicine Vol. 8 No. 3 (2021): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (286.685 KB) | DOI: 10.36408/mhjcm.v8i3.583

Abstract

Latar belakang: Embolisasi distal koroner berkontribusi terhadap tingginya kejadian kardiovaskular mayor (KKVM) pasca intervensi koroner perkutan primer (IKPP). Aspirasi trombus (AT) manual berpotensi mengurangi embolisasi distal dan memperbaiki perfusi mikrovaskular pada pasien sindroma koroner akut dengan elevasi segmen ST (SKA-EST), terutama pasien dengan badai trombus tinggi. Tujuan: Mengetahui pengaruh aspirasi trombus selektif terhadap skor TIMI trombus dan luaran klinis pasca IKPP. Metode: Penelitian retrospektif pada pasien SKA-EST dengan onset ?12 jam dan skor trombus TIMI awal ?3 yang menjalani IKPP dengan aspirasi trombus selektif di RSUP Dr. Kariadi periode Januari 2018 sampai Desember 2019. Luaran klinis yang diobservasi adalah KKVM selama rawat inap yang terdiri dari mortalitas, syok kardiogenik, edema paru akut, aritmia, revaskularisasi ulang, dan stroke. Hasil: Sejumlah 100 pasien memenuhi kriteria, terdiri dari 50 pasien kelompok AT dan 50 pasien kelompok non-AT. Rerata skor trombus TIMI awal kelompok AT dan non-AT, masing-masing 4,76 dan 3,8 (p<0,001). Kelompok AT mengalami penurunan skor trombus TIMI lebih baik dibanding non-AT (4,72 vs. 3,8, p<0,001). Terdapat 8 (16%) pasien kelompok AT dan 11 (22%) pasien non-AT yang mengalami KKVM pasca IKPP (RR 1,08, IK 95% 0,89-1.30, p=0,44). Kesimpulan: Aspirasi trombus selektif mungkin mengurangi tingkat badai thrombus. Aspirasi trombus mungkin menurunkan kejadian kardiovaskular mayor selama rawat inap pasca IKPP pada pasien dengan skor trombus TIMI di atas 4 setara dengan yang memiliki skor trombus TIMI kurang dari 4 tanpa aspirasi trombus.
Co-Authors Della Dafina Sekarsari Erwin Kresnoadi Ilham Uddin Liborius Bramantyo Mochamad Ali Sobirin Robert Adrianto Raharjo Sodiqur Rifqi Susi Herminingsih Udin Bahrudin Yan Herry