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All Journal Heart Science Journal Jurnal Klinik dan Riset Kesehatan
Saidi, Zaki
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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SGLT2 inhibitor, a new bullet in heart failure management Saidi, Zaki; Widito, Sasmojo
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.5

Abstract

The global health landscape is confronted with substantial challenges stemming from diabetes mellitus and heart failure (HF). The escalating incidence of diabetes mellitus (DM), in correlation with HF, underscores the imperative necessity for efficacious strategies in the realm of prevention and management. The most recent advancements in therapeutic approaches, specifically Sodium-glucose transporter 2 inhibitors (SGLT2i), present a promising prospect for enhancing outcomes and addressing the existing gaps in HF management. This paper aims to elucidate the significance of SGLT2i in the therapeutic management of both reduced and preserved heart failure, with or without the presence of DM. SGLT2i are new heart failure drugs. In trials, SGLT2i improved diastolic dysfunction, reduced oxidative stress, inflammation, fibrosis, and myofilament rigidity. The first SGLT2 inhibitor studies, EMPA-REG OUTCOME, DECLARE-TIMI 58, and CANVAS, showed that Empagliflozin and Canagliflozin reduced HF mortality and rehospitalization in type 2 diabetes mellitus (T2DM) patients. Dapagliflozin reduces HF hospitalizations without impacting T2DM mortality. Canagliflozin avoided creatinine rises, kidney disease deaths, and cardiovascular deaths in the CREDENCE Study. SGLT2i improve health in heart failure with preserved ejection fraction (HFpEF). SGLT2i improved health status statistically in the PRESERVED-HF and EMPEROR-Preserved investigations. SGLT2i became known as a promising therapeutic choice in the treatment of HF. The substantial evidence from prominent large-scale clinical trials has substantiated the cardiovascular and renal protective effects of SGLT2i. Furthermore, the benefits of these medications are relevant for individuals who have been diagnosed with heart failure with reduced ejection fraction (HFrEF), as well as those who are experiencing heart failure with preserved ejection fraction (HFpEF).
Analysis of activated clotting time in patients receiving unfractionated heparin with and without continuous infusion during elective percutaneous coronary intervention Saidi, Zaki; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.11

Abstract

  Background: Percutaneous coronary intervention (PCI) involves a risk of thrombotic events. Unfractionated heparin (UFH) remains a preferred antithrombotic agent during PCI, though the optimal administration method is still under debate. Given its narrow therapeutic range, UFH requires careful monitoring through the measurement of activated clotting time (ACT) Objective: The aim is to compare ACT value and the outcomes of administering a bolus of UFH at 70–100 IU/kgBW, with and without a continuous infusion of 2000 IU/hour Methods: An observational retrospective study was conducted on 133 patients who underwent elective PCI by meeting the inclusion and exclusion criteria during the period of July 2022–July 2024. Clinical information, ACT value and the outcome were gathered from medical records. Statistical analyses were performed using SPSS 22, employing univariate, bivariate, and multivariate logistic regression analyses to determine correlations. Result: The range of ACT results of administering an UFH bolus of 70-100 IU/kgBW with continuous infusion 2000 IU/hour was 191 to 426 seconds (mean 281.9 seconds). Among the 44 patients, 66.6% exhibited ACT levels below 300 seconds, 15 patients (22.7%) had ACT levels ranging from 300 to 350 seconds, while 6 patients (8.3%) had ACT levels exceeding this range. The percentage of patients who attained therapeutic success in the unfractionated heparin (UFH) infusion group (22.7%) was significantly higher than the UFH bolus group (5.9%) with statistically significant results (p = 0.000). Complications were observed in both groups, with 1 patient in each group experiencing acute thrombosis (p = 1.000) and no patients experienced bleeding complications. Conclusion: Administering a UFH bolus of 70-100 IU/kgBW with continuous UFH infusion at 2000 IU/hour achieved better optimal ACT values. No significant results were found regarding the risk of acute thrombosis with no bleeding complications.  
TERAPI HEPARIN TIDAK TERFRAKSI PADA PROSEDUR INTERVENSI KORONER PERKUTAN ELEKTIF saidi, zaki; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 3 (2025): Volume 4 No 3, Juni 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.3.6

Abstract

Coronary artery Disease (CAD) occurs due to an imbalance between myocardial oxygen demand and supply due to total or partial blockage of the coronary artery. Occlusion of coronary artery blood vessels in CAD patients requires revascularization to restore blood flow and myocardial perfusion. One of the mechanical revascularization efforts is to perform a percutaneous coronary intervention (PCI) procedure. This technique involves the use of a guided catheter directed to the location of the coronary artery blockage, followed by balloon dilation and stent placement to maintain patency. Blood vessel injury during PCI exposes serine proteases to tissue factor and collagen, stimulating procoagulants that will activate the coagulation cascade. In CAD patients undergoing PCI therapy, periprocedural pharmacotherapy is given in the form of antiplatelet therapy accompanied by intravenous anticoagulants such as unfractionated heparin. Unfractionated heparin produces its main anticoagulant effect by inactivating thrombin and activating factor X (factor Xa) through a mechanism dependent on antithrombin (AT). Intravenous administration of unfractionated heparin in addition to producing anticoagulant effects can also increase the risk of bleeding. In order for the drug to effectively prevent clotting and not cause bleeding, it is necessary to determine the right dose. In connection with this, it is necessary to monitor hemostasis function with optimal Activated Clotting Time (ACT) values ​​to prevent the risk of thrombosis and bleeding in patients undergoing PCI.
Kewaspadaan terhadap Kejadian Stroke pada Pasien Pasca Bedah Pintas Arteri Koroner saidi, zaki; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 5 No 1 (2025): Edisi Oktober 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.05.1.9

Abstract

Coronary artery bypass grafting (CABG) is a leading cause of iatrogenic stroke. According to the literature, the incidence of stroke following CABG ranges from 1.1% to 5.7%, with most strokes occurring within the first 48 hours after surgery. The risk of stroke after CABG is associated with a significantly higher mortality rate. A 62-year-old male patient with risk factors including hypertension and diabetes mellitus, as well as coronary artery disease 3 vessel disease left main disease (CAD3VD LM disease), was scheduled for CABG. Preoperative data indicated cardiomegaly on chest X-ray, normal carotid and extremity duplex ultrasonography, and echocardiography revealed a decreased ejection fraction and Regional Wall Motion Abnormality (RWMA). The CABG procedure lasted 7 hours and was performed using an on-pump technique, with cardiopulmonary bypass (CPB) time of 232 minutes and aortic clamp time of 123 minutes. Two days after the CABG, the patient developed complications in the form of an infarct stroke, which was confirmed by CT imaging. The stroke led to a prolonged hospitalization period, totaling 14 days. The mechanism of post-CABG stroke is divided into embolic and hypoperfusion processes, both influenced by various risk factors. In this patient, risk factors such as hypertension, type II Diabetes Mellitus, decreased ejection fraction, and perioperative factors such as prolonged CPB and aortic clamp times, along with aortic manipulation during the on-pump procedure, contributed to the increased risk of stroke.
Co-Authors Widito, Sasmojo