PENDAHULUAN

• Acute limb ischaemia caused by arterial embolism

or thrombosis of native vessels and grafts is a
common and potentially serious condition.

• Treatment is often initiated by local administration

of thrombolytic therapy, recombinant tissue
plasminogen activator (rtPA), through an indwelling
intra-arterial catheter.
 TUJUAN PENELITIAN
• Evaluate the outcomes with regard to limb salvage,
bleeding complications and survival, taking into
account differences in case mix and method of
treatment.
 Desain study

Retrospective analysis of
prospective databases
from two vascular
centres
 Tinjauan Pustaka
Local intra- Baseline coagulation tests such as platelet
count, APTT and prothrombin complexwere
arterial performed before thrombolysis.
thrombolysis
for lower Arterial access was achieved through
limb puncture of the common femoral artery

ischaemia
thrombolysis catheter was advanced over the
aortic bifurcation and positioned in the
occlusion.
 Tinjauan Pustaka
In Uppsala, the thrombolytic procedure generally started
Local intra- with a bolus dose of 4mg rtPA, followed by 0⋅5mg/h. In
arterial Malmö, the procedure generally started with 1–2 mg/h for
the first 4 h, followed by 0⋅5–1⋅0mg/h. The thrombolytic
thrombolysis treatment seldom exceeded 48 h.

for lower At the start of the endovascular procedure all patients were
given 5000 units heparin intravenously
limb
ischaemia
In Uppsala they received only one bolus dose, whereas in
Malmö the bolus dose was followed by continuous infusions
of heparin, adjusted according to APTT values, aiming for
two to three times baseline.
 Pasien
All patients who received intra-arterial thrombolytic
therapy for lower limb ischaemia, with occlusions
below the abdominal aorta, between 1 January
2001 and 30 September 2012 in Uppsala, and
between 1 January 2001 and 31 December 2010 in
Malmö, were included. Patients were identified
through the local Swedvasc registry (a national
register for vascular procedures, with high
validity)17–19 and local endovascular databases.
The regional ethics review board in Lund approved
the study.
One- Way
SPSS
ANOVA

P value
<0,010

Analisa statistik
Hasil
 Kesimpulan
Local rtPA infusion with, or without
continuous heparin was successful for
the majority of patients, and was
associated with few major bleeding
complications. The difference in case
mix at the two hospitals underlines the
value of the multivariable analysis, as
a direct comparison between the
hospitals could have led to misleading
conclusions regarding the optimal
treatment strategy.
 Telaah kritis
• P : Prehypertensive japanese adults found to be
prehypertensive in 2004 and reexamined in 2009.

• I : adjusments with age, bodymass index, smoking, and

drinking habits, baseline systolic and diastolic BP, DM, CKD,
and serum uric acid.

• C : compare cumulative incidence of hypertension from

prehypertension over 5 y compared with those without
hyperuricemia

• O : hyperuricemia had a significantly higher cumulative

incidence of hypertension (30.1% vs 25.0%; P=0.040)
 Pertanyaan penelitian
• Apakah terdapat hubungan antara usia, BMI,
merokok, kebiasaan minum keras, nilai tekanan
darah sistol dan diastol, Diabetes melitus,
dislipidemia, CKD dan asam surat serum dengan
hipertensi?
 Validitas
Pertanyaan Jawaban
Apakah dilakukan analisis dalam tiap kelompok? Ya
Apakah subjek diacak sehingga sebanding pada Tidak
awal percobaan?
Apakah kelompok-kelompok memperoleh Tidak
kointervensi yang sama? Apakah ada kecukupan
tindak lanjut?
Apakah subjek dan penilai disamarkan terhadap Ya
perlakuan yang diterima dan/atau apakah
pengukurannya objektif?
Apakah setiap kelompoknya sama saat dimulai Ya
penelitian?
 Importance
• There were no significant differences between
women and men (24.4% versus 26.0%; P=0.28). The
cumulative incidence of hypertension in subjects
with hyperuricemia (n=726) was significantly higher
than those without hyperuricemia (n=2858; 30.7%
versus 24.0%; P<0.001).
 Aplikabilitas
Pertanyaan Jawaban
Apakah subjek sama dengan pasien Ya
anda?
Apakah hasil penelitian ini dapat Ya
diintegrasikan dengan nilai-nilai
serta harapan pasien anda?

Elsyamly et all.,
2016