Dr Soehartono DS Thromboemboli TSH

8/16/2019 Dr Soehartono DS Thromboemboli TSH

1/60


2/60

H. Soehartono DS, dr, SpOG, KFER

Bagian / SMF Obstetri & Ginekologi

FK UNAIR / RSUD Dr Soetomo

Surabaya !""#


3/60


4/60

Modern Management of the Menopause

CASTELLANO1967

Bahwa TSH dper!u"an Seumur Hdup

untu" mengatas masa!ah #!ma"ter" dan

$ost Menopausa!


5/60

TSH %apat Menurun"an Mor&dtas dan Morta!tas

'anta Menopause terutama "arena CH%(

Breast Can)er atau Osteopoross

*+O%STE,N 1976 - 199.


6/60

+es"o pema"aan TSH /

#emung"nan menng"atn0a #an"er Buah dada(

Stro"e( ta" &erguna untu" Se)ondar0

$reenton CH% dan menng"atn0a "emung"nan

Throm&oem&o!

'H, Me( 2332


7/60

C,+C4LAT,ON

2331%OC4MENTE% BENE5,TS O5 H+T

+edu)e menopausa! s0mptoms $reenton of osteopoross

B!ood !pd redu)ton

as)u!ar rea)tt0

Ant o8dant

%e)reased apoptoss


8/60


9/60

$,L #ONT+ASE$S,

MEN,N*#AT#AN #EA%,AN TE%

: enous Throm&ho Em&o! %sease ;

SEA# TAH4N 1963

5A#TO+ EST+O*EN


10/60

'AN,TA SEHAT( T,%A# SE%AN* HAM,L %AN T,%A#

MEMA#A, $,L #ONT+ASE$S, :Be)"man;

< "asus TE% %A+, 133=333 'AN,TA $E+ TAH4N

'AN,TA MEMA#A, $,L #ONT+ASE$S,

1< "asus TE% %A+, 133=333 'AN,TA $E+TAH4N

'AN,TA HAM,L

63 "asus TE% %A+, 133=333 'AN,TA $E+ TAH4N

AN*#A #EA%,AN TE%

: 'a!"er - 4=# ;


11/60

$A%A A'ALN>A / T,%A# A%A $EN*A+4H TSH TE+HA%A$ TE%

A#H,+ ? A#H,+ ,N, /

TSH MEN,N*#AT#AN TE% 2 ? . @ LEB,H BESA+

:*utham;

$,L #ONT+ASE$S, EST+O*EN E#SO*EN S,NTET,#

TSH EST+O*EN E#SO*EN ALAM,AH


12/60

4M4+ .< - 6. TAH4N

*EM4#

ME+O#O#

TEN%ENS, A%A *AN**4AN $EMBE#4AN %A+AH

M4TAS, *ENET,# $A%A $EMBE#4AN %A+AH: $rothrom&ot) Mutaton atau 5a"tor Herdter Throm&oph!a ;

AN*#A #EA%,AN TE% MEN,N*#AT


13/60

4M4+ 23 ? 9 TAH4N /

3=6 #AS4S %A+, 1333 'AN,TA TAH4N

4M4+ .3 ?


14/60

$u!monar0 Em&o!sm

TH+OMB4S

TH+OMBOS,S ENA T+OMBOS,S A+TE+,

:enous Throm&oem&o!sm; :Artera! Throm&oss;

%eep en Throm&oss ,nfar" M0o)ardStro"e


15/60

TH+OMB4S $A%A ENA?%ALAM

TE+4TAMA $A%A #A#,

M4LA, TA# A%A *EALA SAM$A, A%A TAN%A +A%AN*(N>E+, %AN TAN%A ,N5LAMAS,

: Tda" sama dengan $h!e&ts ;

LEB,H T,N**, ENA >AN* TE+S4MBAT(*EALA LEB,H BE+AT

%EE$ E,N TH+OMBOS,S


16/60

B!a ter"ena pem&u!uh darah &esar

$4LMONA+> EMBOL,SM

N>E+, 'A#T4 BE+NA5AS

$A+4 B,SA TA# BE+54N*S,


17/60


18/60


19/60


20/60


21/60


22/60


23/60


24/60


25/60


26/60


27/60


28/60


29/60


30/60


31/60


32/60


33/60


34/60

T E O + ,

5A#TO+ S,STEM,#

5A#TO+ LO#AL

$E+BE%AAN BLOO% 5LO'


35/60

*enet)s Mutatons pada /

5a"tor :Leden( *uann( Adenne;

5a"tor ,, :Throm&oph!a( $rothrom&n;

$ema"aan Estrogen E"sogen

$ema"aan $rogesteron *eneras #etga

:*estoden dan %esogestre!;

#eham!an

5A#TO+ S,STEM,#


36/60

5A#TO+ LO#AL

Endothe!a! %amage

The +upture of The 5&rous Cap Coerng

4nsta&!e $!aues

Menng"atn0a Tssue 5a)tors : T5 ;

$ro)oagu!ant %seu!&rum Hemostat)s Ba!an)e


37/60

BLOO% 5LO'

$er&edaan B!ood 5!ow 5e!o)t0 pada uDungArter dan ena

Tur&u!ens A!ran %arah


38/60


39/60

MENO$A4SE

MEN,N*#AT

TE+A%, $E+4BAHAN

5A#TO+ ,, 5A#TO+ ,,,

5,B+,NO*EN +ES,#O ASC4LA+ %,SEASE COA*4LAT,ON ,NH,B,TO+S ANT,TH+OMB,N $+OTE,N C


40/60

17 wanta $remenopause dan $ostmenopause

H0po Estrogensm o="= Oaran 5a!ure

Mengganggu Sstem Hemostass

$redsposs terDadn0a Throm&oem&o!

*LAS*O' dan NOTELO,TF


41/60

$EN*A+4H EST+O*EN

TE+HA%A$ S,STEM HEMOSTAS,S

A"ttas Antthrom&n ,,, &er"urang

5&rn 5ormaton menng"at

Throm&oe!astograph0 menurun

B!ood Coagu!o&!t0 menng"at

ON #A4LLA dan STAN*EL


42/60

T S H

MEN4+4N#AN

MEN,N*#AT#AN 5,B+,NOL,S,S

MEN**AN**4 #OA*4LAS,

5,B+,NO*EN 5A#TO+ ,,

EN%OTHEL,AL ACT,AT,ON MA+#E+ :',LLEB+AN%S 5ACTO+; ANT,TH+OMB,N


43/60

TSH G S,STEM #OA*4LAS,

SCA+AB,N et=a!

O+AL EST+O*EN

S,*N,5,CANT - +E%4CT,ON

5,B+,NO*EN

5ACTO+ ,,

ON ',LLEB+AN% 5ACTO+SOL4BLE TH+OMBO MO%4L,N

T,SS4E $LASM,NO*EN ACT,ATO+ :t - $A;

MEN**AN**4 $+OSES #OA*4LAS,


44/60

TSH G 5,B+,NOL,S,S

#'AN* #ON #OH 2332:$EMA#A,AN E G $ SELAMA 6 B4LAN;

$enurunan $!asma $!asmnogen A)tator

,nh&tor - 1 : $A, - 1 ; se&esar 2. ? :$ 3(32;

$enurunan $A, - 1 A)tt0 se&esar


45/60

COA*4LAT,ON AN% 5,B+,NOL>S,S 5ACTO+S

Fa$tors t%at a'or $lotting Fa$tors t%at a'or $lotting

(%en in$rease) (%en )e$rease)

*oagulation Fibrinogen Antit%rombin III

Fa$tors Fa$tors +II, +III -rotein * -rotein S

Fibrinolysis -lasminogen Anti.lasmin

Fa$tors -lasminogen a$ti'ator in%ibitor


46/60

,M$L,#AS, #L,N,#

A#T,AS,

#OA*4LAS,

A#T,AS,

5,B+,NOL>S,S

TA# SE,MBAN*

M4TAS, 5A#TO+ LE,%EN

TSH Dangan d&er"an pada wanta res"o C=H=%

Throm&oem&o! menng"at 8 !pat

Menng"at"an res"o ,nfar" M0o)ard


47/60


48/60

$O$4LAT,ON BASE% ST4%> :4N,TE% STATE;

TE% G H+T ++ (6 :9


49/60

HOS$,TAL BASE% :4= #,N*%OM;

4M4+ .< - 6. tahun

TE% G H+T ++ (< :9


50/60

$O$4LAT,ON BASE% :4= #,N*%OM;

TE% I H+T ++ 2(1 :9


51/60

E$,%EM,OLO*,CAL ST4%,ES O5 TE AN% H+T

+eport Stud0 %esgn +e!ate +s" A&so!ute +s"

Authors

)" et=a! $opu!aton &ased nested 2=1?6= dependent on 9133=333 s

)ase )ontro! stud0 n dosefor )urrent users 2133=333 4SA 193 ? 199. for dophat) TE women0r for

non users

users of H+T

%a!0 et=a! Hospta! &ased )ase =< :9


52/60

MA>( 2332

Estrogen I $rogestn $!a)e&o Haard +ato

0otal number o 123"4 12"!

(omen

In'asi'e breast 44 !# 2!4

$an$er

Nonin'asi'e #" 55 25 6NS7

breast $an$er *8D 44 !! 2!9

*8D )eat% 55 !4 21

Nonatal stroke 55 94 25!

Stroke " :! 2#

Fatal stroke 4 5 2!"

Nonatal stroke 9# 39 23"

-ulmonary embolism :" 5 !25

Dee. 'enous 3 3! !2":

t%rombosis 6D+07


53/60


54/60

$EMBE+,AN TSH SEH4B4N*AN TE%

Tda" per!u s)reenng throm&oph!a=

Anamnesa hstor0 pasen atau fam! tentang TE%=

$erhat"an res"o tam&ahan fa"tor predsposs TE%=

B!a ada hstor0 TE% !anDut"an s)reenng

throm&oph!a=

B!a tda" ada tanda throm&oph!a "onse!ng

+s" G Beneffts=

B!a ada tanda throm&oph!a ruDu" "e ah!n0a= B!a a"an operas &esar TSH ta" per!u d stop han0a

per!u !ow dose heparn=

,NEST,*AT,ON 5O+ $OTENT,AL TH+OMBO$H,L,A


55/60

,NEST,*AT,ON 5O+ $OTENT,AL TH+OMBO$H,L,A

Throm&oph!a S)reen

? A)tated parta! throm&op!ast) tme and prothrom&n tme? Antthrom&n a)tt0

? $roten C a)tt0

? Tota! and free proten S antgen

? Modfed a)tated proten C resstan)e :after pred!uton n

5a)tor def)ent p!asma;

? $rothrom&n gene 23213a arant

? Lupus ant)oagu!ant and ant)ardo!pn ant&odes :,g* and ,gM;

%NA Studes

? 5a)tor Leden :f modfed A$C resstan)e a&norma!;

+outne Haemato!og0 and Bo)hemstr0

? 5u! &!ood )ount n)!udng p!ate!et )ount :to e8)!ude throm&o?

)0thaema;

? 4rea and e!e)tro!0tes( !er fun)ton test and urna!0ss for proten

+,S# 5ACTO+S 5O+


56/60

+,S# 5ACTO+S 5O+

ENO4S TH+OMBOEMBOL,SM :T;

Age 63 0

E8tense surger0 $reous T Mar"ed mmo&!t0( pre or post operate MaDor orthoped) surger0 5ra)ture of pe!s( femur or t&a

Ma!gnan)es H0per)oagu!a&!e states O&est0 $regnan)0 Estrogen use

enu!ts $ost operate sepss Hea!th fa!ure ,nf!amator0 &owe! dsease Sepss M0o)arda! nfar)ton


57/60


58/60

#A$AN TSH HA+4S %,HENT,#AN

; Su))en se'ere $%est .ain 6e'en i not ra)iating to let arm7<

; Su))en breat%lessness 6or $oug% (it% bloo)staine) s.utum7<

; Se'ere .ain in $al o one leg<

; Se'ere stoma$% .ain<

; Serious neurologi$al ee$ts in$lu)ing .rolonge) %ea)a$%e<

; 8e.atitis, =aun)i$e, li'er enlargement<

; Se'ere )e.ression<

; Bloo) .ressure abo'e systoli$ 4" mm8g an) )iastoli$

"" mm8g2


59/60

$ENATALA#SANAAN

Hent"an TSH

Trom&o!t"

Ant "oagu!ant

Operas menge!uar"an &e"uan darah


60/60

Dr Soehartono DS Thromboemboli TSH

Documents