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Dr.Alwi Shahab SpS
Bagian Neurologi FK UNSRI
RSMH PALEMBANG
USAHA PENCEGAHAN ISCHEMIC STROKE
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Stroke
menyebabkan kematian dan kecacatan
Beban bagi keluarga/masyarakat
Perlu deteksi dini dan
penanganan cepat/tepat oleh setiap dokter
Pengenalan : Stroke prone person
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STROKE
Dinegara maju• penyebab kematian nomor 3• penyebab kecacatan yang tinggi• insiden 2 - 5% / jumlah penduduk/tahun
Di Indonesia ??• Diperkirakan 340.000 / tahun (Junaidi)• Ada kecendrungan meningkat (Teguh Ranakusuma)
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Faktor Resiko Stroke
Tak dapat dirubah• Usia• Jenis kelamin• Ras• Keturunan
Dapat dirubah• Hipertensi• Penyakit jantung• DM• Hypercholesterolemi
a• Merokok• TIA / pernah stroke• Penyakit A.Carotis
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Faktor Resiko Stroke (1/3)
Masih dalam penelitian1. Arterial - aortic arch atherome - migraine
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Faktor Resiko Stroke (2/3)
2. B l o o d• lipoprotein (a)/LA(a)• oral contraceptive,• hormone replacement therapy• hyperhomocysteinemia,• alcohol• drug abuse• hypercoagulable state• antiphospholipid antibody (aPL),• anticardiolipidin(aCL)• lupus anticoagulant (LA)• Antithrombin III (AT III)• Protein C Deficiency• Protein S deficiency• Factor V Leiden
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3.Cardiac• Patent foramen ovale• Atrial septal aneurysm• Mitral valve• Prolaps valvular strands• Spontaneous echo contras• Physical activity
Faktor Resiko Stroke (3/3)
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Faktor stroke di Indonesia• Hipertensi 73.9%• merokok 20.45 %• prior stroke 19.9 %• Penyakit jantung iskemik 19.9%• Diabetes Melitus 17.3%• hiperkolesterolemia 16.4 %• Atrial fibrilasi 5.8 %• penyakit katup jantung 3.4 %• polisitemia 1.7 %• pil kontraseptif 1.5 %• Alkohol 1.4 %
Jusuf Misbach;Penelitian multisenter RS di Indonesia;1996
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Faktor Resiko Utama Stroke di RSMH Palembang
Tahun 2000 - 2002• Hipertensi 606 69%
• Diabetes Melitus 55 6 %
• Penyakit Jantung 56 6 %
• Hyper Lipidemia 153 17 %
• Lain – lain 12 1 %
Jumlah 88 100 %
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Thrombosis
• Pembentukan clot platelet dan fibrin dalam pembuluh darah
• Merupakan hasil perubahan dari satu atau lebih komponen hemostatis
• Dipermudah oleh : dinding pembuluh darah yang kasar aliran darah yang lambat viskositas yang tinggi
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Thrombosis
• Ketidak seimbangan antara faktor thrombogenik dan mekanisme proteksi
• merupakan proses yang dinamik
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Pencegahan Stroke
• Pengenalan dan
pengontrolan faktor resiko stroke
• Stroke prone person
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Pencegahan Primer
• Memasyarakatkan gaya hidup sehat
• Mengenali stroke prone person
obati dengan baik
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Gaya Hidup Sehat
• 1.Mengatur pola makan yang sehat
• 2.Stop merokok
• 3.Hindari alkohol dan penyalahgunaan obat
• 4.Olahraga teratur
• 5.Hindari stress dan istirahat yang cukup
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Data jumlah penderita stroke
di RSMH & RS Charitas
Tahun RSMH RS Charitas Jumlah
1997 1998 1999 2000 2001
539 383 384 508 542
351 246 421 466 533
890 629 805 974
1075
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Faktor risiko stroke dan risiko relatif
Risk factors Relative risk Modification effect
Hypertension 6 X Beneficial, proven
Smoking 2 X Beneficial, proven
Diabetes mellitus 2 - 4 X Beneficial, unproven
Atrial fibrillation 3 X Beneficial, proven
Coronary artery disease 2 - 6 X Beneficial, unproven
Recent TIA or stroke 10 X Beneficial, proven
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Pencegahan Stroke
Usaha Promotif P. Primer P. SekunderSasaran Orang sehat, FR (factor Pasca TIA,
FR: Negatif resiko): positif pasca strokeTujuan Mencegah Mencegah Mencegah TIA
FR TIA/Stroke stroke ulangCara Gaya Hidup Gaya HS, Gaya HS,
Sehat (HS) kendalikan FR kendalikan FRTerapi obatTerapi bedah
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Pencegahan Sekunder Stroke
Pencegahan pada penderita T.I.A. atau yang pernah stroke
Keberhasilan Terapi Anti Platelet
* Cilostazol 41,7%
* Dip + ASA 37%
* Clopidogrel 33%
* ASA 31%
* Ticlopidin 30,2%
* Pentoxifilin 28%
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Pencegahan sekunder
• Pravastatin 23%
• Ramipril 32%
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Aterosklerosis
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Kerja Triatec
Inhibition of atherosclerotic "Plaque-ACE"Activity by ACE Inhibitors (I)
Possible antiatherosclerotic mechanism of Triatec:
Endothelial dysfunction
Thrombosis Inflammation Vascular lesionsRemodeling
Plaquerupture
PlaqueuLocal Mediators
VCAMICAM
Cytokines
EndothelinPAI-1 Growth factors Proteolysis
Ang II
Bradykinin NO
accord. to Pepine C, Can J Cardiol 14; suppl D (1998)
Ang II
Triatec 10 mgImprovement
Reduction of clinical sequelae
Vaso-constriction
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Terima Kasih
PT. Aventis Pharma