Dr Soehartono DS Thromboemboli TSH
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H. Soehartono DS, dr, SpOG, KFER
Bagian / SMF Obstetri & Ginekologi
FK UNAIR / RSUD Dr Soetomo
Surabaya !""#
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Modern Management of the Menopause
CASTELLANO1967
Bahwa TSH dper!u"an Seumur Hdup
untu" mengatas masa!ah #!ma"ter" dan
$ost Menopausa!
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TSH %apat Menurun"an Mor&dtas dan Morta!tas
'anta Menopause terutama "arena CH%(
Breast Can)er atau Osteopoross
*+O%STE,N 1976 - 199.
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+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
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C,+C4LAT,ON
2331%OC4MENTE% BENE5,TS O5 H+T
+edu)e menopausa! s0mptoms $reenton of osteopoross
B!ood !pd redu)ton
as)u!ar rea)tt0
Ant o8dant
%e)reased apoptoss
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$,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
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'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 $E+ TAH4N
AN*#A #EA%,AN TE%
: 'a!"er - 4=# ;
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$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
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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: $rothrom&ot) Mutaton atau 5a"tor Herdter Throm&oph!a ;
AN*#A #EA%,AN TE% MEN,N*#AT
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4M4+ 23 ? 9 TAH4N /
3=6 #AS4S %A+, 1333 'AN,TA TAH4N
4M4+ .3 ?
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$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
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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
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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,
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T E O + ,
5A#TO+ S,STEM,#
5A#TO+ LO#AL
$E+BE%AAN BLOO% 5LO'
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*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,#
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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
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BLOO% 5LO'
$er&edaan B!ood 5!ow 5e!o)t0 pada uDungArter dan ena
Tur&u!ens A!ran %arah
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MENO$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
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17 wanta $remenopause dan $ostmenopause
H0po Estrogensm o="= Oaran 5a!ure
Mengganggu Sstem Hemostass
$redsposs terDadn0a Throm&oem&o!
*LAS*O' dan NOTELO,TF
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$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
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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
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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 $+OSES #OA*4LAS,
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TSH G 5,B+,NOL,S,S
#'AN* #ON #OH 2332:$EMA#A,AN E G $ SELAMA 6 B4LAN;
$enurunan $!asma $!asmnogen A)tator
,nh&tor - 1 : $A, - 1 ; se&esar 2. ? :$ 3(32;
$enurunan $A, - 1 A)tt0 se&esar
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COA*4LAT,ON AN% 5,B+,NOL>S,S 5ACTO+S
Fa$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$ti'ator in%ibitor
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,M$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
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$O$4LAT,ON BASE% ST4%> :4N,TE% STATE;
TE% G H+T ++ (6 :9
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HOS$,TAL BASE% :4= #,N*%OM;
4M4+ .< - 6. tahun
TE% G H+T ++ (< :9
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$O$4LAT,ON BASE% :4= #,N*%OM;
TE% I H+T ++ 2(1 :9
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E$,%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
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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
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$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
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,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+
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+,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 $ost operate sepss Hea!th fa!ure ,nf!amator0 &owe! dsease Sepss M0o)arda! nfar)ton
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#A$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
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$ENATALA#SANAAN
Hent"an TSH
Trom&o!t"
Ant "oagu!ant
Operas menge!uar"an &e"uan darah
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