Anggia Endah Satuti
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Significance of Six Minute Walking Distance in Predicting Functional Capacity Status of Patients with Pulmonary Hypertension Complicating an Atrial Septal Defect Anggia Endah Satuti; Dyah Wulan Anggrahini; Lucia Krisdinarti
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17789

Abstract

Background: Six minute walk test (6 MWT) is a sub-maximal exercise test that measures an integrated response of all systems responsible during exercise. Pulmonary arterial hypertension (PAH) is a problem encountered by patients with atrial septal defect (ASD). Assessment of functional capacity in patients with PAH based on the WHO functional classifi cation remains a powerfulpredictor of survival in these patients. The World Health Organization functional classifi cation is a subjective tool because it is based on anamnesis of ordinary activity. On the contrary, 6 MWT is an objective tool to measure functional capacity of patients with pulmonary hypertension. Objective: To determine the walking distance obtained using 6 MWT as a measurement of functionalcapacity in ASD patients with PAH. Methods: A cross sectional study was used to determine the walking distance as a measurement of functional capacity in ASD patient with PAH. This study was a sub-study of an Atrial Septal DefectRegistry done in RSUP Dr. Sardijto, Yogyakarta, since 2012. Pulmonary arterial pressure was measured using Pulmonary Arterial Systolic Pressure (PASP) obtained from echocardiography. Pulmonary hypertension was divided into three categories based on PASP, mild with PASP of less than 45 mmHg, moderate with PASP of 45-59 mmHg and severe with PASP of more than 60 mmHg. All patients did 6 MWT to measure their functional capacity. The relationship between 6 MWT distance and severity of PAH was measured using Pearson correlation analysis. Results: Forty-three patients were included in this study with 32 female patients (74%) and 11 male patients (26%) with an age range of 17-70 years old. Forty-four patients (44%) with ASD had severe PAH. The mean of 6 MWT distance was 337 m. There were signifi cant differences between mild, moderate and severe PAH in correlation with the 6 MWT distance (p= 0.001). The patients with severe PAH had only 278 m walking distance compared to those with mild PAH who had 394 m walking distance. There was a significant relationship between the 6 MWT distance and severity of PAH (p=0.01). This study showed that 6 MWT correlates negatively with the severity of PAH. We found that the higher pulmonary arterial pressure, the shorter walking distance (p=0.01, r -0,506). Conclusion: ASD defect patients with severe PAH had shorter walking distance compared to those with mild PAH. The 6 MWT is a reliable and objective measurement of functional capacity for ASD patients with PAH.
The Role of Anticoagulant and Thrombolysis in The Management of Deep Vein Thrombosis Anggia Endah Satuti; Hariadi Hariawan; Hasanah Mumpuni
ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17792

Abstract

Deep vein thrombosis (DVT) is a clinical challenge encountered by clinicians of all specialties. The major complication to date is thrombus embolization into the lung which can be fatal. The mainstay of DVT therapy is an anticoagulant to prevent the thrombus development and recurrence. However, anticoagulant has no direct thrombolysis effect and recanalization of DVT largely depends on the effectiveness of the endogenous fi brinolytic system. Many agents are developed to improve the outcome and prevent a post thrombotic syndrome (PTS). The aim of this review is to give explanation on the use of anticoagulant, especially vitamin K antagonist, warfarin and thrombolytic therapy in DVT.
Efficacy of Lumbrokinase and Warfarin Compared to Single Warfarin on Thrombus Resolution in Deep Vein Thrombosis Anggia Endah Satuti; Hariadi Hariawan; Hasanah Mumpuni
ACI (Acta Cardiologia Indonesiana) Vol 1, No 2 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17798

Abstract

Background: Deep vein thrombosis (DVT) is a challenging condition for clinician in all specialities. Prognosis after vein thromboembolism is worse and much worse after pulmonary embolism. Anticoagulant is the mainstay therapy for deep vein thrombosis, but there is still slow thrombus resolution even with the use of optimal anticoagulant. The use of intravenous thrombolytic agentsis one of the methods to signifi cantly lyse thrombus. Since there is increasing risk of bleeding with the use of the agents, indication is limited. Lumbrokinase is oral thrombolytic that may give significant thrombus lyses without increasing the risk of bleeding for deep vein thrombosis. This study was conducted to compare single warfarin therapy with combination of lumbrokinase andwarfarin for thrombus resolution in deep vein thrombosis patients. Methods: This study was a randomized open labeled trial comparing deep vein thrombosis patients using single warfarin therapy group to group using combination lumbrokinase and warfarin. 22 patients meet the inclusion and exclusion criteria. Patients were followed for 30 days and in the end of the trial, evaluation using vascular Doppler ultrasonography was done. Chi-square analysis was used to compare the outcome between two therapy groups. Results: In this trial, group therapy with added lumbrokinase to warfarin yielded a tendency toward better thrombus resolution compared to group with single warfarin therapy (58.3% vs.30%, p=0.231). Conclusion : Added therapy with lumbrokinase to warfarin may give better thrombus resolution as compared to single warfarin therapy, although there is no signifi cant difference between groups.Keywords: deep vein thrombosis, lumbrokinase, warfarin