Scientific Journal

Pemberian Antikoagulan pada Kehamilan dengan Risiko Trombosis

Rudy Afriant, Zulherman — Tue, 01 Sep 2026 00:00:00 +0000

Tromboemboli vena (TEV) merupakan komplikasi serius yang dapat terjadi selama kehamilan dan masa nifas. Kehamilan secara fisiologis menciptakan keadaan hiperkoagulabel akibat perubahan hemostasis, termasuk peningkatan faktor koagulasi dan penurunan aktivitas fibrinolitik. Kondisi ini meningkatkan risiko TEV sekitar 4–5 kali lipat dibandingkan populasi non-hamil, dengan insidensi tertinggi terjadi pada 6 minggu pertama pascapersalinan. Secara global, kejadian TEV diperkirakan mencapai 1–2 kasus per 1.000 kehamilan. Risiko meningkat signifikan pada wanita dengan trombofilia, riwayat TEV sebelumnya, imobilisasi, obesitas, kehamilan ganda, atau pasca tindakan pembedahan. Antikoagulan merupakan terapi utama untuk pencegahan dan penatalaksanaan TEV dalam kehamilan. Heparin tidak terfraksinasi (UFH) dan low molecular weight heparin (LMWH) merupakan pilihan yang aman karena tidak melintasi plasenta, dengan LMWH lebih disukai karena profil farmakokinetiknya yang stabil dan risiko efek samping lebih rendah. Sebaliknya, warfarin bersifat teratogenik dan DOACs belum direkomendasikan karena keterbatasan data keamanan. Penulisan tinjauan pustaka ini bertujuan memberikan gambaran komprehensif mengenai epidemiologi, faktor risiko, serta prinsip pemilihan dan pemberian antikoagulan selama kehamilan, untuk mendukung pengambilan keputusan klinis yang tepat.

Beyond Cytology: Integrating Molecular Testing into Diagnostic Algorithm of Indeterminate Thyroid Nodules

Wed, 09 Sep 2026 00:00:00 +0000

Background: Thyroid nodules represent the most pervasive endocrine neoplasia, detectable in over 50% of the adult population via high-resolution ultrasonography. While the vast majority are benign, approximately 20% of fine-needle aspiration (FNA) biopsies yield indeterminate cytological results, carrying an unpredictable risk of malignancy (ROM) ranging from 10% to 40%. Historically, this diagnostic ambiguity necessitated repeat biopsies or diagnostic hemithyroidectomy, often exposing patients with benign disease to unnecessary surgical risks and lifelong supplementation. Main Body: Over the past decade, advancements in high-throughput sequencing have enabled the integration of molecular testing into the diagnostic algorithm of indeterminate thyroid nodules. Current molecular platforms primarily utilize DNA- and RNA-based next-generation sequencing (NGS) to detect oncogenic driver mutations (e.g., BRAF, RAS), gene fusions (RET/PTC, PAX8/PPARγ), copy number variations, and altered microRNA (miRNA) expression profiles. These assays function through two primary paradigms: "rule-out" tests characterized by high sensitivity and negative predictive value (NPV) to avoid unnecessary surgeries, and "rule-in" tests with high specificity and positive predictive value (PPV) to guide definitive oncological resections. Prominent commercial platforms, such as the Afirma Genomic Sequencing Classifier (GSC) and ThyroSeq v3, have revolutionized risk stratification by refining indeterminate categories (Bethesda III and IV) into distinct molecular phenotypes. Conclusion: Integrating molecular testing into clinical practice refines risk stratification, curtails diagnostic hemithyroidectomies, and personalizes surgical management. However, its implementation must be individualized, considering institutional cancer prevalence, cost-effectiveness, and ultrasound characteristics.

Perioperative Management of Patients with Hypothyroidism

Tue, 08 Sep 2026 00:00:00 +0000

Hypothyroidism is an endocrine disorder characterized by reduced thyroid hormone production and may increase the risk of perioperative complications due to cardiovascular, respiratory, metabolic, and altered anesthetic responses. Perioperative management should therefore be tailored to the severity of hypothyroidism and the urgency of surgery. In elective surgery, optimization of thyroid function with levothyroxine and achievement of a euthyroid state are generally recommended before surgery, particularly in patients with overt or severe hypothyroidism. Anesthetic management requires careful selection and dosing of anesthetic agents, adequate hemodynamic and respiratory monitoring, maintenance of body temperature, and prevention of factors that may precipitate cardiovascular or respiratory compromise. Postoperative care should include close monitoring for cardiovascular, respiratory, metabolic, and neurological complications, including myxedema coma. In emergency surgery, the need for timely surgical intervention should be balanced against the severity of hypothyroidism. Surgery may proceed when clinically necessary, with appropriate perioperative thyroid hormone replacement and supportive management; intravenous levothyroxine may be considered in severe hypothyroidism when oral administration is not feasible. A structured approach based on the severity of thyroid dysfunction and surgical urgency is essential to reduce perioperative morbidity and mortality. Achieving a euthyroid state remains the preferred goal before elective surgery whenever clinically feasible.