VTE Maut Dalam Senyap

Segalanya hanya berpunca apabila kaki kanannya tertendang tayar motosikal ketika dia cuba mengalihkan kenderaan tersebut. Serta merta kuku ibu jarinya lebam dan selepas berminggu-minggu berlalu rasa sakit pada bahagian tersebut semakin terasa.

Fariq lantas mendapatkan rawatan perubatan apabila kuku ibu jarinya bertukar hitam dan sejak itu selama tiga bulan dia berulang-alik ke hospital bagi mencuci lukanya namun masih tidak juga sembuh.

Pada masa sama keadaan kesihatannya mula merosot, dia cepat letih manakala mata, telinga dan telinga sedikit demi sedikit bertukar kuning.

Pada Disember 2011 iaitu kira-kira tiga bulan selepas insiden kecil itu, keadaan Fariq bertambah teruk. Dia tidak boleh jalan dengan elok dan tindak balas terhadap sekelilingnya mula merosot sehinggalah dia mengalami demam teruk dan tumbang sebaik sahaj dibawa ke hospital.

Fariq didapati mengalami septicaemia dan autoimmune haemolytic anaemia (AIHA) iaitu penyakit berkaitan dengan kemerosotan sistem ketahanan badan. Dia terpaksa diberi bantuan pernafasan dan pemindahan darah serta diberi antibiotik bagi merawat penyakitnya.

Dia dimasukan ke unit rawatan rapi (ICU) selama seminggu sebelum dipindahkan ke wad biasa dan diletakkan di bawah pemantauan doktor selama sebulan.

Pada Februari 2012 dia dibenarkan keluar dan dirujuk ke pakar hematologi di hospital lain bagi merawat gejala AIHA yang dialami. Pemeriksaan oleh pakar hematologi, mendapati dia mengalami kadar rentak jantung dan pernafasan laju yang tidak normal (tachycardia).

Pemeriksaan segera menggunakan Computer Tomography Pulmonary Angiogram (CTPA) mendapati salur darah Fariq tersumbat akibat darah beku (blood clot) di kedua-dua paru-parunya atau dikenali sebagai embolisme pulmonari.

“Laporan doktor memang mengejutkan saya dan isteri. Doktor memberi rawatan gabungan suntikan heparin dengan berat molekul rendah dan warfarin. Saya juga perlu belajar untuk menyuntik sendiri ubat tersebut selain perlu mematuhi diet pemakanan tertentu sepanjang pengambilan ubat tersebut.

“Saya juga perlu berulang-alik ke hospital untuk mejalani ujian darah (INR) yang sedikit sebanyak telah menjejaskan rutin hidup harian saya,” katanya.

Pada April 2012, Fariq mendapati kaki kirinya bengkak dan apabila ke hospital doktor menyarankan dia menjalani imbasan Doppler. Hasil imbasan menunjukkan sekali lagi ada darah beku pada salur darah di peha kiri (DVT).

Ternyata rawatan yang diambil terdahulu kurang berkesan lalu doktor menyarankan rivaroxaban, satu rawatan oral terbaru bagi merawat tromboembolisme vena (VTE).

VTE ancam nyawa

Apa yang dialami oleh Fariq merupakan antara gejala yang biasa dialami oleh ramai penduduk dunia.

Embolisme pulmonari dan DVT merupakan gejala penyumbatan saluran darah atau tromboembolisme vena (VTE) yang menjadi punca kematian utama di seluruh dunia dan dianggarkan sebagai penyakit vaskular (berkaitan sistem pembuluh darah) ketiga paling umum selepas sakit jantung iskemia dan strok.

Embolisme pulmonari yang merupakan salah satu bentuk VTE, berlaku apabila darah beku di dalam salur darah (vena) kaki atau pelvis pecah dan bergerak ke paru-paru lalu menyekat satu atau lebih saluran darah di dalam organ penting tersebut.

Tanpa rawatan segera, paru-paru akan kehilangan fungsinya dan boleh menyebabkan kematian dengan pantas.

Gejala embolisme pulmonari termasuk sesak nafas, sakit dada dan kadar denyutan jantung pantas, dan sesetengah orang juga mungkin mengalami batuk berdarah.

Pakar Runding Hematologi Kanan, Hospital Ampang, Dr. Jameela Sathar, berkata, VTE lazimnya tidak ketara dari segi klinikal dan dalam kebanyakan kes, tanda pertama penyakit ialah embolisme pulmonari yang membawa maut.

Katanya, kira-kira satu pertiga atau 34 peratus daripada kematian VTE berpunca daripada embolisme pulmonari iaitu maut secara tiba-tiba.

“Darah beku adalah berbahaya dan kesannya boleh membawa mudarat, apatah lagi ramalan terperinci mengenai kejadian VTE adalah sukar diperolehi kerana penyakit ini sukar disahkan menerusi diagnosis,

“Malah bagi pesakit yang disahkan menghidap penyakit tersebut, kadar kematian melebihi 15 peratus pada tiga bulan pertama selepas diagnosis,” katanya pada taklimat mengenai rawatan an penggunaan Xarelto (rivaroxaban) oleh Bayer HealthCare di Kuala Lumpur, baru-baru ini.

Menurut Dr. Jameela lagi, kelulusan rivaroxaban sebagai ubat oral tunggal menandakan titik perubahan pertama dalam rawatan dan pencegahan darah beku yang mengancam nyawa di kalangan pesakit embolisme pulmonari.

Katanya, ubat ini tidak melibatkan suntikan atau memerlukan pengawasan dari masa ke masa serta mempunyai hubung kait yang minimum dengan makanan serta ubat.

Lebih penting lagi, rivaroxaban mengatasi terapi piawai yang berasaskan suntikan yang dari segi langkah keselamatan penting bagi rawatan awal dan jangka panjang embolisme pulmonari.

“Kini kita boleh menawarkan pilihan rawatan yang pantas dan berkesan yang boleh memberikan perlindungan selagi ia diperlukan,” katanya.

Menurut Dr. Jameela lagi, selama beberapa dekad ini, terapi piawai bagi VTE ialah kombinasi dwiubat yang diberikan menerusi suntikan merangkumi heparin dengan berat molekul rendah untuk sekurang-kuranngya lima hari, yang diberikan bersama warfarin (sejenis antagonis vitamin K oral) yang memerlukan pengawasan darah yang kerap.

Pesakit perlu terus mengambil warfarin untuk sekurang-kurangnya tiga bulan.

“Pendekatan rawatan piawai ini mungkin agak rumit bagi pakar perubatan dan membebankan pesakit. Cabaran utama termasuk kemasukan hospital berpanjangan, dan memerlukan pesakit mematuhi diet serta jadual rawatan secara berdisiplin walaupun selepas keluar hospital.

“Hakikatnya, ini amat mencabar kerana warfarin boleh berinteraksi dengan mudah dengan makanan biasa seperti sayur hijau berdaun dan juga ubat umum, dan pesakit mungkin tidak dapat memanfaatkan kesan terapeutik terhad warfarin dan mungkin tidak dilindungi dengan sewajarnya,” kata Dr. Jameela.

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