KENNETH SULIYANTO

GANGGUAN KOAGULASI XC062192006

PADA PASIEN SEPSIS SUPERVISOR PEMBIMBING:

dr. Ari Santri Palinrungi Sp. An, KIC
DEFINISI
Sepsis merupakan kumpulan gejala inflamasi sistemik yang
disertai dugaan ataupun terbukti terdapat infeksi. Gejala inflamasi
sistemik tersebut ditandai oleh dua atau lebih abnormalitas pada
suhu, jumlah leukosit, takikardi dan takipnu.
Koagulopati - kondisi di mana kemampuan darah untuk membeku
terganggu dan digunakan untuk mewakili kondisi tidak teratur
yang mencakup keadaan hemoragik dan trombotik.
PATOFISIOLOGI
1. Pembentukan trombin yang diperantarai TF
2. Gangguan mekanisme antikoagulan
a) Sistem antitrombin
b) Sistem protein C
c) Tissue factor pathway inhibitor (TFPI)
3. Penghentian sistem fibrinolisis
GAMBARAN KLINIS
Aktivasi koagulasi sistemik fisiologis
Non-overt disseminated intravascular coagulation
Transient consumption coagulopathy
Overt DIC
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
trombotik mikroangiopati
heparin induced thrombocytopenia
TREATMENT
1. Terapi pengganti - konsentrat trombosit dan faktor koagulasi
2. Antikoagulan
3. Pengembalian jalur antikoagulan - konsentrat APC (Activated
Protein C), TFPI (Tissue Factor Pathway Inhibitor)
4. Agen lain - Rekombinan FVIIa
ANTICOAGULANT
Parenteral
Heparin, LMWH, Fondaparinux, Parenteral Direct Thrombin
Inhibitors (lepirudin dan desirudin, argatroban, and bivalirudin)
Oral
Warfarin, New Oral Anticoagulants (dabigatran, mentarget
thrombin; rivaroxaban, pixaban, and edoxaban, mentarget factor
Xa.)
PERBANDINGAN DENGAN
COVID
DAFTAR PUSTAKA
Morgan, G. E., Mikhail, M. S., & Murray, M. J. (2006). Clinical anesthesiology. New York: Lange Medical Books/McGraw Hill Medical
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Toshiaki Iba, Jerrold H. Levy; Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation. Anesthesiology 2020; 132:1238–
1245/10.1097/ALN.0000000000003122
Faranita, Tri & Trisnawati, Yunnie & Lubis, Munar. (2016). Gangguan Koagulasi pada Sepsis. Sari Pediatri. 13. 226.
10.14238/sp13.3.2011.226-32.
Iba T, Umemura Y, Watanabe E, Wada T, Hayashida K, Kushimoto S; Japanese Surviving Sepsis Campaign Guideline Working Group for
disseminated intravascular coagulation. Diagnosis of sepsis-induced disseminated intravascular coagulation and coagulopathy. Acute Med
Surg. 2019 Apr 1;6(3):223-232. doi: 10.1002/ams2.411. PMID: 31304023; PMCID: PMC6603393.
Toshiaki Iba, Jerrold H. Levy, Jean Marie Connors, Theodore E. Warkentin, Jecko Thachil, Marcel Levi; The unique characteristics of
COVID-19 coagulopathy; Crit Care. 2020; 24: 360. 10.1186/s13054-020-03077-0
Levi M, van der Poll T. Coagulation and sepsis. Thromb Res. 2017 Jan;149:38-44. doi: 10.1016/j.thromres.2016.11.007. Epub 2016 Nov 19.
PMID: 27886531.
Hadid, Tarik et al. “Coagulation and anticoagulation in COVID-19.” Blood reviews vol. 47 (2021): 100761. doi:10.1016/j.blre.2020.100761
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