Year: 2024
Type: article
Study design: Case Report
Abstract: Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune condition that causes abnormalities in the blood clotting system and often manifests as venous thromboembolic events (deep vein thrombosis and acute pulmonary embolism). Management of APS patients with acute pulmonary embolism presents a major challenge for clinicians because it requires a rapid and accurate diagnosis because it greatly affects the long-term prognosis Case: A 23-year-old man with complaints of shortness of breath since 2 weeks and worsening in 1 day, electrocardiography examination showed S1Q3T3, echocardiography found a picture of right atrial and right ventricular dilatation, MC Connel sign (+), suspicion of thrombus in the lateral right ventricle. The results of a CT scan of pulmonary angiography showed an intraluminal thrombus in the main pulmonary artery to the left pulmonary artery. Duplex ultrasonography of the right and left inferior extremities found a labile thrombus in the left popliteal vein (size 0.2 cm). Optimal anticoagulant therapy using enoxaparin 0.6 ml subcutaneously for 10 days, and successfully discharged. Further evaluation with the results of 2 microglobulin 2.88 mg/L and ANA IF titer 1:100 confirmed the presence of systemic lupus erythematosus and APS. During outpatient care, the patient was given oral anticoagulant therapy rivaroxaban (6 months) and angiopulmonary CT evaluation after anticoagulant therapy was completed with no residual thrombus found in the pulmonary artery. Conclusion: Early diagnosis and therapy greatly affect the prognosis in patients with acute pulmonary embolism. Finding the underlying disease and optimal therapy for the condition will prevent recurrence in the future. Long-term use of anticoagulants accompanied by close monitoring of bleeding symptoms and repeat echocardiography and angiopulmonary CT evaluation should be performed within six months after anticoagulant therapy. Pendahuluan: Sindrom antifosfolipid (APS) merupakan kondisi autoimun sistemik yang menyebabkan kelainan sistem pembekuan darah dan sering memberikan manifestasi kejadian tromboemboli vena (thrombosis vena dalam dan emboli paru akut). Tatalaksana pada pasien APS dengan emboli paru akut memberikan tantangan yang besar bagi klinisi karena membutuhkan diagnosis yang cepat dan tepat karena sangat mempengaruhi prognosis jangka Panjang Kasus: Laki-laki usia 23 tahun dengan keluhan sesak nafas sejak 2 minggu dan memberat dalam 1 hari, pemeriksaan elektrokardiografi menunjukkan adanya S1Q3T3, ekokardiografi menemukan adanya Gambaran dilatasi atrium kanan dan ventrikel kanan, tanda MCConnell (+), kecurigaan thrombus pada lateral ventrikel kanan. Hasil CT scan angiografi pulmonal menunjukkan adanya thrombus intraluminal pada arteri pulmonal utama hingga arteri pulmonal kiri. Ultrasonografi duplex ekstremitas inferior kanan dan kiri menemukan adanya trombus labil pada vena popliteal kiri (ukuran 0.2 cm). Terapi anticoagulant optimal menggunakan enoksaparin 0.6 ml subkutan selama 10 hari, dan berhasil dipulangkan. Evaluasi lanjutan dengan hasil β2 microglobulin 2.88 mg/L dan ANA IF titer 1:100 memberikan konfirmasi adanya Systemic lupus erythematosus dan APS. Selama rawat jalan pasien diberikan terapi antikoagulan oral rivaroxaban (6 bulan) dan evaluasi CT angio pulmonal setelah terapi antikoagulan tuntas dengan tidak ditemukan residual trombus pada arteri pulmonalis. Simpulan: Penegakan diagnosis dan terapi awal sangat mempengaruhi prognosis pada pasien emboli paru akut. Menemukan penyakit dasar dan terapi optimal kondisi tersebut akan mencegah kekambuhan pada masa mendatang. Penggunaan antikoagulan jangka panjang dibarengi dengan monitoring ketat terhadap gejala pendarahan serta evaluasi ulangan ekokardiografi dan CT angio pulmonal harus dilakukan dalam periode enam bulan pasca terapi antikoagulan.
Source: Intisari Sains Medis
Institution: Udayana University
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4402184456