Risiko Kejadian Perdarahan Pasca Rawat Inap pada Penggunaan Bersamaan Warfarin dan Antibiotik

Nazulanita Rahma, Tri Murti Andayani, Arief Nurrochmad

Abstrak


Penggunaan warfarin dan antibiotik bersamaan diketahui dapat meningkatkan risiko perdarahan. Kejadian perdarahan mayor terkait warfarin dapat berupa perdarahan fatal hingga menyebabkan kematian. Penelitian ini bertujuan untuk menganalisis interaksi warfarin dan antibiotik dan efeknya terhadap kejadian perdarahan pada pemeriksaan pertama pasca rawat inap di RSUD Wates. Desain studi berupa kohort retrospektif pada 67 kasus penggunaan warfarin dengan/tanpa antibiotik oleh pasien rawat inap. Data berupa diagnosis, terapi, pemeriksaan pendukung, dan kejadian perdarahan saat rawat inap hingga pemeriksaan pertama diambil dari rekam medik pasien tertanggal Januari 2018 hingga September 2020. Analisis data dilakukan secara statistika menggunakan ­uji Chi-square atau uji Fisher exact test dan uji independent t-test atau uji Mann Whitney U test. Terdapat perbedaan bermakna pada kejadian perdarahan dalam waktu 7 hari pasca rawat inap antara kelompok antibiotik dan kontrol (16%; 0%; p = 0.017). Antibiotik yang digunakan oleh pasien dengan kejadian perdarahan yaitu golongan sefalosporin, kuinolon, azitromisin, dan ampisilin-sulbaktam. Kejadian perdarahan yang terjadi meliputi hematemesis melena (25%), hematuria (50%), tidak diketahui (25%). Studi ini menyimpulkan bahwa penggunaan bersamaan warfarin dan antibiotik saat rawat inap dapat berpengaruh terhadap kejadian perdarahan dalam waktu 7 hari setelah pasien dipulangkan.Penggunaan warfarin dan antibiotik bersamaan diketahui dapat meningkatkan risiko perdarahan. Kejadian perdarahan mayor terkait warfarin dapat berupa perdarahan fatal hingga menyebabkan kematian. Penelitian ini bertujuan untuk menganalisis interaksi warfarin dan antibiotik dan efeknya terhadap kejadian perdarahan pada pemeriksaan pertama pasca rawat inap di RSUD Wates. Desain studi berupa kohort retrospektif [A1] [A2] pada 67 kasus penggunaan warfarin dengan/tanpa antibiotik oleh pasien rawat inap. Data berupa diagnosis, terapi, pemeriksaan pendukung, dan kejadian perdarahan saat rawat inap hingga pemeriksaan pertama diambil dari rekam medik pasien tertanggal Januari 2018 hingga September 2020. Analisis data dilakukan secara statistika menggunakan ­uji Chi-square atau uji Fisher exact test dan uji independent t-test atau uji Mann Whitney U test. Terdapat perbedaan bermakna pada kejadian perdarahan dalam waktu tujuh hari pasca rawat inap antara kelompok antibiotik dan kontrol (16%; 0%; p = 0.017). [A3] [A4] Antibiotik yang digunakan oleh pasien dengan kejadian perdarahan yaitu azitromisin, ampisilin-sulbaktam, golongan sefalosporin, dan golongan kuinolon.[A5] [A6]  Kejadian perdarahan yang terjadi meliputi hematemesis melena (25%), hematuria (50%), tidak diketahui (25%). Studi ini menyimpulkan bahwa penggunaan bersamaan warfarin dan antibiotik saat rawat inap dapat berpengaruh terhadap kejadian perdarahan dalam waktu tujuh hari setelah pasien dipulangkan

 [A1]Penulis disarankan mempelajari artikel https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398292/ untuk lebih memahami penulisan artikel dengan desain kohort.

 [A2]Baik, terimakasih

 [A3]Tampilan hasil uji dalam studi kohort (adjusted hazard ratio [AHR] = ?; 95% CI, ?; p-value = )

 [A4]Tidak dilakukan analisis survival, sementara kejadian perdarahan pada control group adalah 0 sehingga RR adalah tidak terbatas

 [A5]Ini bukan golongan obat; untuk menghindari multitafsir..kedua obat ini ditulis di awal, sementara yang golongan obat di bagian setelahnya

 [A6]Sudah kami ubah redaksionalnya


Kata Kunci


warfarin; antibiotik; perdarahan; pasca rawat inap

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Referensi


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DOI: https://doi.org/10.25077/jsfk.8.2.164-173.2021

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