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"Pendahuluan: Saat ini, pengobatan antiplatelet tunggal menggunakan aspirin atau clopidogrel direkomendasikan untuk pasien penyakit arteri perifer (PAD) pasca-revaskularisasi. Namun, penelitian terbaru menyarankan bahwa kombinasi rivaroxaban dan aspirin lebih menguntungkan. Kami melakukan tinjauan sistematis untuk menentukan efikasi dan keamanan kombinasi rivaroxaban dan aspirin dibandingkan dengan aspirin saja. Metode: Kami melakukan tinjauan sistematis berdasarkan Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Pencarian dilakukan di Cochrane, PubMed, Scopus, EBSCOHost, dan Google Scholar menggunakan kata kunci. Kriteria inklusi dan eksklusi diterapkan. Studi yang dipilih dinilai menggunakan Cochrane risk of bias tool versi 2 untuk inklusi. Studi yang terpilih diekstraksi untuk karakteristik dan hasil. Hasil dianalisis secara kualitatif dan kuantitatif. Kami menggunakan model efek tetap atau acak untuk menentukan rasio tergabung yang sesuai. Interval kepercayaan 95% dan nilai p kurang dari 0,05 digunakan sebagai indikator signifikansi statistik. Hasil: Dua studi terkontrol acak multicenter dimasukkan setelah pencarian dan penilaian dengan risiko bias rendah. Kedua studi menunjukkan hasil efektivitas primer yang lebih baik dalam kelompok kombinasi dan perbaikan risiko perdarahan mayor. Analisis kuantitatif menemukan tingkat komplikasi PAD yang lebih rendah (OR=0,79; 95% CI=0,66–0,95) termasuk infark miokard, stroke, kematian kardiovaskular, dan iskemia tungkai akut. Kelompok kombinasi memberikan hasil keamanan primer (OR=1,32; 95% CI=1,06–1,67) dan sekunder (OR=1,47; 95% CI=1,19–1,84) yang lebih rendah. Kesimpulan: Kombinasi rivaroxaban dan aspirin memberikan hasil klinis yang lebih baik pada pasien PAD pasca-revaskularisasi. Namun, kombinasi ini harus digunakan dengan hati-hati karena dapat meningkatkan risiko perdarahan pada populasi tersebut.

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Introduction: Currently, single antiplatelet treatments using aspirin or clopidogrel were recommended for post-revascularization peripheral artery disease (PAD) patients. However, recent study suggested that combination of rivaroxaban and aspirin was more favorable. We conducted a systematic review to determine efficacy and safety of rivaroxaban and aspirin combination compared to aspirin alone. Method: We conducted a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Searching was conducted on Cochrane, PubMed, Scopus, EBSCOHost, and Google Scholar using keywords. Inclusion and exclusion criteria were applied. Selected studies were appraised using Cochrane risk of bias tool v.2 for inclusion. Included studies were extracted for characteristics and outcomes. Outcomes were analyzed qualitatively and quantitatively. We used fixed- or random-effect model to determine pooled ratio per appropriate. A 95% confidence interval and p-value of 0.05 and below were used as indicators of statistical significance. Results: Two multicentered, randomized controlled studies were included after searching and appraisal with low risk of bias. Both studies showed greater primary effectivity outcome in combination group and improvements of major bleeding risk. Quantitative analysis found lower PAD complications rate (OR=0.79; 95% CI=0.66–0.95) which including myocardial infarct, stroke, cardiovascular death, and acute limb ischemia. Combination group provided lesser primary (OR=1.32; 95% CI=1.06–1.67) and secondary (OR=1.47; 95% CI=1.19–1.84) safety outcome. Conclusion: Combination of rivaroxaban and aspirin provided better clinical outcome in postrevascularization PAD patients. However, this combination should be used carefully as this yield larger risk of bleeding in the population."

"[LATAR BELAKANGPenyebab terbanyak Penyakit Arteri Perifer (PAP) pada usia diatas 40 tahun adalah aterosklerosis. Prevalensi penyakit aterosklerosis perifer meningkat pada kasus dengan diabetes melitus, dislipidemia, hipertensi dan perokok. Critical Limb Ischemia (CLI) merupakan manifestasi dari PAP berat, CLI dikaitkan dengan risiko kehilangan tungkai yang sangat tinggi. Pada pasien CLI tanpa adanya revaskularisasi, pasien biasanya akan dilakukan amputasi dalam hitungan minggu atau bulan. Revaskularisasi secara terbuka memiliki morbiditas yang cukup banyak. Seiring kemajuan teknologi, revaskularisasi secara terbuka perlahan-lahan digantikan dengan adanya intervensi endovaskuler dalam dua dekade terakhir. Revaskularisasi endovaskuler di Departemen Ilmu Bedah RSCM baru mulai dilakukan pada tahun 2012 dan di Indonesia saat ini belum ada studi yang menilai hasil dari tindakan revaskularisasi.METODEMetode yang diambil adalah analitik komparatif berpasangan dengan disain penelitian longitudinal pre-post study. Selama Agustus 2013 hingga Agustus 2014 didapatkan 16 pasien yang masuk kriteria inklusi. Dilakukan pengambilan data nilai ABI sebelum dan sesudah revaskularisasi endovaskuler. ABI digunakan sebagai penilaian efektivitas revaskularisasi.HASILHasil didapatkan nilai mean ABI sebelum tindakan 0,7±0,118 dan nilai mean ABI sesudah tindakan 0,844±0,127. Didapatkan peningkatan nilai ABI sesudah tindakan 0,14. Dari hasil uji T berpasangan didapatkan nilai p=0,001. Secara statististik didapatkan peningkatan yang signifikan antara nilai ABI sebelum tindakan dan sesudah tindakan.KESIMPULANDapat ditarik kesimpulan tindakan revaskularisasi endovaskuler terhadap pasien PAP efektif berdasarkan nilai ABI;BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI, BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI]"

"ABSTRAKLatar Belakang. Kejadian aterosklerosis, dilaporkan lebih sering pada pasien lupus eritematosus sitemik (LES) dibandingkan individu tanpa LES, salah satunya adalah penyakit arteri perifer (PAP). Klorokuin diduga memiliki efek protektif terhadap kejadian PAP melalui penekanan kadar sitokin proinflamasi dan efek menurunkan kadar kolesterol, namun beberapa penelitian lain menunjukkan bahwa klorokuin meningkatkan kadar sitokin proinflamasi. Hingga saat ini, penelitian mengenai pengaruh klorokuin belum pernah dilakukan pada populasi pasien LES di Indonesia.Tujuan Penelitian. Mengetahui pengaruh klorokuin terhadap kejadian PAP pada pasien LES wanita berusia 40 tahun ke bawah.Metode Penelitian. Studi kasus kontrol dilakukan terhadap pasien LES wanita berusia 40 tahun ke bawah di RS Cipto Mangunkusumo selama Juni-Agustus 2012 yang tidak menderita diabetes melitus ataupun hipertensi sebelum diagnosis LES ditegakkan. Pasien dengan penyakit autoimun selain LES dan gagal ginjal kronik dieksklusi dari penelitian. Pengaruh klorokuin terhadap PAP pada pasien LES dinyatakan dalam odds ratio (OR). Peran variabel perancu dinilai pada analisis regresi logistik berjenjang sehingga didapatkan adjusted OR.Hasil Penelitian. Dari 18 subjek yang menderita PAP (kelompok kasus), sebanyak 8 (44,4 %) menggunakan klorokuin dan dari 72 subjek yang tidak menderita PAP (kelompok kontrol), 20 (27,8 %) di antaranya menggunakan klorokuin. Setelah dilakukan adjustment terhadap variabel perancu (usia, lama menderita sakit, dislipidemia, dan aktivitas penyakit), tidak didapatkan hubungan yang bermakna antara penggunaaan klorokuin dengan kejadian PAP pada pasien LES wanita berusia di bawah 40 tahun (adjusted OR 2,44; IK95 % 0,76 sampai 7,87).Simpulan. Pengaruh klorokuin terhadap kejadian PAP pada pasien LES wanita berusia 40 tahun ke bawah belum dapat disimpulkan pada penelitian ini.

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ABSTRACTBackground. Atherosclerosis is enhanced in systemic lupus erythematosus (SLE) compared to general population, one of which is peripheral arterial disease (PAD). Chloroquine has protective effects in peripheral arterial disease through the suppression of proinflamatory cytokine levels and lipid lowering effect, although other studies have shown the increasing of cytokine levels by chloroquine. To date, no studies have ever been performed to investigate the effect of chloroquine on peripheral arterial disease in Indonesian lupus patients.Aims. To investigate the effects of chloroquine on peripheral arterial disease in patients with systemic lupus erythematosus aged forty-year-old and below.Methods. A case control study including female lupus patients aged forty year-old and younger in Cipto Mangunkusumo Hospital between June-August 2012, who do not suffer from diabetes mellitus and/or hypertension before the diagnosis of lupus is confirmed. Patients with other autoimmune disease than lupus and/or with chronic kidney disease were excluded from the study. Effect of chloroquine on peripheral arterial disease in lupus patients is expressed in odds ratio (OR). The role of confounding factors analyzed with multiple logistic regression to estimate the adjusted OR.Results. Eight (44.4 %) of the total 18 subjects contracting PAD (case group) and 20 (27.8 %) of the total 72 subjects without PAD (control group) were using chloroquine. After adjustments towards confounding factors (age, disease duration, dyslipidemia, and disease activity) were completed, the results showed there was no considerable relation between the use of chloroquine and PAD case in female SLE patients aged below forty-year-old (adjusted OR 2.44; 95 % CI 0.76 to 7.87).Conclusion. The effect of chloroquine usage on PAD case in female SLE patients aged forty-year-old and below can not be concluded from this study."

"[ABSTRAK Salah satu komplikasi dari Peripheral Arterial Disease (PAD) adalah kerusakan tungkai bawah hingga tidakdapat digunakan untuk beraktifitas. PAD disebabkan oleh gangguan vaskular yang menyebabkan atherosklerotikpada vaskular di bagian distal. Suatu penelitian kohort di Swedia menyatakan bahwa penyembuhan primer, lajuamputasi dan mortalitas pada pasien PAD berhubungan dengan derajat insufisiensi vaskular. Dengan demikian perlu dilakukan penelitian untuk mengetahui karakteristik vaskular pada kasus PAD secara kuantitatif maupun kualitatif serta hubungannya dengan nilai Ankle Brachial Index (ABI) dan gambaran gelombang Doppler Ultrasonography(DUS). Metode penelitian menggunakan studi potong lintang. Hasil penelitian didapatkanpasien PAD dengan nilai ABI rata-rata 0,7 dengan gambaran gelombang DUS yang berubah dari trifasikmenjadi non-tirfasik dominan pada arteri infrapopliteal. ABI di bawah 0.9 menunjukkan perubahan pada gelombang DUS dari arteri femoralis hingga a.dorsalis pedis dengan nilai p <0.05. Faktor-faktor risiko yang paling tampak adalah usia di atas 45 tahun yang menunjukkan peningkatan risiko PAD. Selain itu hubunganABI dan faktor ?faktor risiko menunjukkan bahwa hiperlipidemia dan diabetes melitus menunjukkan hubungan signifikan dengan p<0,05. Sedang pada hubungan DUS dan faktor-faktor risiko hanya usia >45 tahun yangtampak secara statistik signifikan meski secara klinis faktor-faktor risiko yang lain menunjukkan jumlahpersentase yang diatas 50%. Disimpulkan bahwa dengan mengetahui nilai ABI dapat ditentukan derajatkeparahan PAD dan juga dengan mengetahui gelombang DUS saja maka dapat diketahui oklusi di tingkat segmen arteri yang mana.Selain itu, usia di atas 45 tahun, hiperlipidemia dan juga diabetes melitus merupakan faktor risiko yang penting untuk terjadinya atherosklerosis dan penyumbatan pada distal arteri. Penggunaan DUS untuk menentukan tingkat penyumbatan sangat informatif dalam hal penggambran gelombang, aman dan murah sehingga dapat menetukan tindakan selanjutnya.ABSTRACT One of the complications of Peripheral Arterial Disease (PAD) is the damage that can be made to the lower

extremities causing difficulties to perform any activities with it. PAD is caused by vascular insufficiency known as atherosclerotic of the distal vascular. A cohort research in Sweden described that the primary recovery, amount of amputation and mortaltiy of PAD patients is related to the degree of vascular insufficiency. As for which, a research should be made to endorsed the knowhow of the vascular characteristics on PAD patients

quantitatively and qualitatively in accordance to ABI value and DUS spectral waveform. Methods used is cross

sectional. The result was, PAD patients had mean ABI value of 0.7 with changes of DUS spectral waveform

from triphasic to non-triphasic dominantly seen in infrapopliteal arteries. ABI less than 0.9 has a significant value towards changes in the spectral waveform from the femoral artery to the dorsal pedis artery. The risk factors such as age above 45 years old shows a significant relationship with the increase in PAD risk (p <0.05). Besides that, p <0.05 was also seen in hyperlipidemia and diabetes mellitus patients with PAD. As for the

relation between DUS and the risk factors, age above 45 years old was seen significant statistically eventhough

clinically all risk factors showed a percentage above 50%. It is concluded that by knowing the ABI value, the

degree of severity of PAD can be acknowledge and by knowing the waveform of DUS only one can know the

level of occlusion in an arterial segment. Besides that, age above 45 years, hyperlipidemia and diabetes mellitus are the important risk factors that causes atherosclerosis and occlusion in distal arteries. The usage of DUS to evaluate the level of occlusion is very informative showing images, it?s safe, low cost and can indicate towards future intervention. ;One of the complications of Peripheral Arterial Disease (PAD) is the damage that can be made to the lower

extremities causing difficulties to perform any activities with it. PAD is caused by vascular insufficiency known as atherosclerotic of the distal vascular. A cohort research in Sweden described that the primary recovery, amount of amputation and mortaltiy of PAD patients is related to the degree of vascular insufficiency. As for which, a research should be made to endorsed the knowhow of the vascular characteristics on PAD patients

quantitatively and qualitatively in accordance to ABI value and DUS spectral waveform. Methods used is cross

sectional. The result was, PAD patients had mean ABI value of 0.7 with changes of DUS spectral waveform

from triphasic to non-triphasic dominantly seen in infrapopliteal arteries. ABI less than 0.9 has a significant value towards changes in the spectral waveform from the femoral artery to the dorsal pedis artery. The risk factors such as age above 45 years old shows a significant relationship with the increase in PAD risk (p <0.05). Besides that, p <0.05 was also seen in hyperlipidemia and diabetes mellitus patients with PAD. As for the

relation between DUS and the risk factors, age above 45 years old was seen significant statistically eventhough

clinically all risk factors showed a percentage above 50%. It is concluded that by knowing the ABI value, the

degree of severity of PAD can be acknowledge and by knowing the waveform of DUS only one can know the

level of occlusion in an arterial segment. Besides that, age above 45 years, hyperlipidemia and diabetes mellitus are the important risk factors that causes atherosclerosis and occlusion in distal arteries. The usage of DUS to evaluate the level of occlusion is very informative showing images, it?s safe, low cost and can indicate towards future intervention. , One of the complications of Peripheral Arterial Disease (PAD) is the damage that can be made to the lower

extremities causing difficulties to perform any activities with it. PAD is caused by vascular insufficiency known as atherosclerotic of the distal vascular. A cohort research in Sweden described that the primary recovery, amount of amputation and mortaltiy of PAD patients is related to the degree of vascular insufficiency. As for which, a research should be made to endorsed the knowhow of the vascular characteristics on PAD patients

quantitatively and qualitatively in accordance to ABI value and DUS spectral waveform. Methods used is cross

sectional. The result was, PAD patients had mean ABI value of 0.7 with changes of DUS spectral waveform

from triphasic to non-triphasic dominantly seen in infrapopliteal arteries. ABI less than 0.9 has a significant value towards changes in the spectral waveform from the femoral artery to the dorsal pedis artery. The risk factors such as age above 45 years old shows a significant relationship with the increase in PAD risk (p <0.05). Besides that, p <0.05 was also seen in hyperlipidemia and diabetes mellitus patients with PAD. As for the

relation between DUS and the risk factors, age above 45 years old was seen significant statistically eventhough

clinically all risk factors showed a percentage above 50%. It is concluded that by knowing the ABI value, the

degree of severity of PAD can be acknowledge and by knowing the waveform of DUS only one can know the

level of occlusion in an arterial segment. Besides that, age above 45 years, hyperlipidemia and diabetes mellitus are the important risk factors that causes atherosclerosis and occlusion in distal arteries. The usage of DUS to evaluate the level of occlusion is very informative showing images, it’s safe, low cost and can indicate towards future intervention. ]"