KORELASI UJI KUALITAS TROMBOSIT AGONIS ADP KADAR 2 M, 5 M, 10 M, DENGAN MPV PADA PASIEN RIWAYAT STROKE ISKEMIK YANG

MENDAPAT TERAPI CLOPIDOGREL Egha Zainur Ramadhani, Usi Sukorini Bagian Patologi Klinik FK UGM/RSUP Dr. Sardjito Yogyakarta ABSTRAK/INTISARI Latar Belakang Penelitian. Stroke merupakan penyebab kematian terbanyak kedua di dunia dan ketiga di indonesia. Dua-pertiga stroke adalah stroke iskemik, dimana reaktivitas trombosit berperan dalam patogenesisnya, sehingga obat antiplatelet seperti Clopidogrel digunakan dalam manajemen terapi. uji kualitas/agregasi trombosit digunakan untuk monitoring terapi ini. Reaktivitas trombosit dapat pula diketahui dari ukuran trombosit yaitu MPV. Tidak banyak informasi terkait efek obat anti-platelet dengan ukuran trombosit, meski ada bukti in vitro, Clopidogrel dapat menghambat kenaikan MPV terkait ADP. Tujuan Penelitian. Penelitian ini bertujuan untuk mengetahui korelasi hasil uji kualitas trombosit agonis ADP kadar 2 M, 5 M, 10 M, dengan MPV pada pasien riwayat stroke iskemik yang mendapat terapi Clopidogrel. Metode Penelitian. Penelitian menggunakan desain potong lintang. Subyek adalah pasien riwayat stroke iskemik di RSUP Dr Sardjito yang mendapat terapi Clopidogrel. Karakteristik dasar diperoleh dari kuesioner. Data MPV dan hasil agregasi trombosit diukur dengan alat Sysmex XS-800i dan Aggram Agregometer. Analisis statistik menggunakan uji Korelasi dan uji Annova dengan sistem komputerisasi. Hasil Penelitian. Diperoleh 33 pasien, sebagian besar adalah laki-laki (78,8 %), berusia >60 tahun (66,6 %), memiliki riwayat merokok (93,9 %), dan mendapat terapi Clopidogrel >1 tahun (63,7 %). Mayoritas hasil agregasi trombosit adalah hipoagregasi (60,7 %). Tidak terdapat perbedaan rerata MPV pada kelompok hipoagregasi, normoagregasi, dan hiperagregasi (p>0,005, p=397). Pada uji korelasi tidak didapatkan korelasi pada semua variabel yang di uji (MPVADP 2 M, r=-0,225, p=0,209; MPVADP 5 M, r=-0,176, p=0,328; MPVADP 10 M, r=-0,201, p=0,263) Kesimpulan dan Saran. Tidak terdapat korelasi antara uji kualitas Trombosit agonis ADP 2 M, 5 M dan 10 M dengan MPV pada pasien riwayat stroke iskemik yang mendapat terapi Clopidogrel. Disarankan penelitian lain dengan desain prospektif cohort, menggunakan sampel yang lebih besar, menyertakan kriteria inklusi dan eksklusi yang lebih lengkap, serta mempertimbangkan peluang resistensi obat anti-platelet. Kata Kunci: Stroke Iskemik, Clopidogrel, MPV, Uji Kualitas Trombosit, ADP.

CORRELATION BETWEEN PLATELET QUALITY TEST AGONIST ADP 2 M, 5 M, 10 M, WITH MPV IN PATIENTS WITH HISTORY OF ISCHEMIC STROKE GIVEN CLOPIDOGREL THERAPY Egha Zainur Ramadhani, Usi Sukorini Clinical Pathology Dep. Medical Faculty UGM/RSUP Dr. Sardjito, Yogyakarta ABSTRACT Background. Stroke is the second largest cause of death in the world and third in Indonesia. Two-thirds of the stroke is ischemic stroke, where the reactivity of platelets plays an important role in pathogenesis, so that anti-platelet drugs such as Clopidogrel is used in therapeutic management. Platelets quality/aggregation test is used for monitoring the therapy. Platelet reactivity may also be known from the platelet size, from MPV parameter. There are few information about the effects of anti-platelet drugs with platelet size, although there is an in vitro evidence, that clopidogrel inhibits the ADP-related increase in MPV. Objectives. This study aims to determine the correlation between platelet quality test agonist ADP 2 m, 5 m, 10 m, with MPV in patients with history of ischemic stroke given Clopidogrel therapy. Methods. This is cross-sectional study. Subjects were patients with history of ischemic stroke in RSUP Dr. Sardjito who received Clopidogrel therapy. Baseline characteristics obtained from the questionnaires. MPV and the platelet aggregation was measured with a Sysmex XS-800i and Aggram Agregometer. Statistical analysis using correlation test and Annova with computerized systems. Results. There are 33 patients that include in this study, mostly were male (78.8%), age >60 years (66.6%), had a history of smoking (93.9%), and received Clopidogrel therapy >1 year (63.7%). The majority of the results of platelet aggregation is hypoaggregation (60.7%). No mean difference of MPV between hypoaggregation, normoaggregation, and hyperagregation (p>0.005, p=0.397). No correlation in all tested variables (MPV-2 M ADP, r=-0.225, p=0.209; MPVADP 5 M, r=-0.176, p=0.328; MPV-ADP 10 M, r=-0.201, p=0.263) Conclusions and Recommendations. There is no correlation between platelet quality test agonist ADP 2 m, 5 m, 10 m, with MPV in patients with history of ischemic stroke given Clopidogrel therapy. Its suggested to perform another study with prospective cohort design, using a larger sample with more complete inclusion and exclusion criteria, and considering the chances of anti-platelet drug resistance. Keywords: Ischemic Stroke, Clopidogrel, MPV, Platelets Quality Test, ADP.