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Hematology-Medical Oncology Division, Dept of Internal Medicine School of Medicine, Sumatera Utara Unversity 2009
Arteri mesenterial --> Akut abdomen A t i/V Arteri/Vena mata --> Vi t Visus terganggu/buta t /b t A t i telinga Arteri t li --> Sudden deafness > S dd d f DLL dapat terjadi pada wanita atau pria
PEMERIKSAAN PENUNJANG
ANGIOGRAFI: - DVT (flebografi) dan AIL (arteriografi) ( g ) ( g ) - AIL tromboembolik: tidak perlu DUPLEX ULTRASOUND: - DVT sensitivitas 93 % spesifisitas 98 % DVT: iti it %, ifi it Bila hasil (-): ulangi 1 hari & 1 minggu kemudian Calf venous thrombosis: sensitivitas 60 % - AIL : - stratifikasi derajat iskemia & prediksi hasil terapi - Ankle-brachial index (ABI): Normal ABI > 1,0 ABI berat < 0,5
PROFILAKSIS ANTIKOAGULAN
Faktor Risiko Trombosis Usia tua Obesitas Riwayat DVT / PE Insufiensi jantung I fi ij t Kanker Stroke Varises vena Insufiensi vena Faktor Pencetus
Imobilisasi Plaster gips tungkai Pembedahan/Pasca bedah b d h Kehamilan /persalinan /pasca partus Infark miokard akut Infeksi Kontrasepsi oral
PROFILAKSIS ANTIKOAGULAN
PROPHYLACTIC REGIMENS
Compression stockings Standard heparin: 5000 units BTD TID Two steps warfarin: warfarin started 2 weeks befor operations to achieve INR 1.5, then increase post operatively to INR 2 - 3 One step warfarin: start warfarin night of surgery to achieve goal INR of 2 3 Dalteparin: - low risk surgery 2500 u every day, - high risk abdominal surgery 5000 u every day Enoxaparin: - abdominal surgery 40 mg/day - orthopedic indications 30 mg/day g y