Efektivitas Penggunaan Asam Folat Dalam Memperbaiki Luaran Fungsional Pasien Stroke Iskemik Akut

https://doi.org/10.22146/farmaseutik.v18i3.66230

Ratih Rakasiwi(1), Zullies Ikawati(2*), Ismail Setyopranoto(3)

(1) Faculty of Pharmacy, Universitas Gadjah Mada
(2) Department of Pharmacology, Faculty of Pharmacy, Universitas Gadjah Mada
(3) Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Hiperhomositeinemia terjadi pada pasien stroke iskemik akut dan dapat memperburuk luaran terapi karena bersifat neurotoksik. Asam folat merupakan salah satu pilihan terapi yang dapat menurunkan kadar homosistein. Studi mengenai efektivitas asam folat pada pasien stroke iskemik akut masih terbatas. Penelitian ini bertujuan untuk mengetahui efektivitas penggunaan asam folat dalam membantu memperbaiki luaran fungsional dan mengurangi durasi rawat inap pasien stroke iskemik akut. Penelitian dilakukan secara observasional-analitik dengan desain kohort retrospektif. Dari 168 pasien yang memenuhi kriteria inklusi, diperoleh 72 pasien menerima asam folat dan 96 pasien sebagai kelompok kontrol dimana tidak menerima asam folat selama rawat inap. Efektivitas penggunaan asam folat dalam membantu memperbaiki luaran fungsional diukur menggunakan skala Modified Barthel Index (MBI) dengan membandingkan perubahan skor MBI antara kedua kelompok ketika masuk rumah sakit dan ketika evaluasi pada minggu pertama perawatan. Perubahan skor MBI pada kelompok asam folat dan kelompok kontrol masing-masing sebesar 3,03±2,79 dan 2,55±2,59 (p=0,343) dengan rerata durasi rawat inap selama 7,12±1,44 dan 7,46±1,84 hari (p=0,442). Penggunaan asam folat selama pengamatan pada minggu pertama tidak signifikan secara statistik baik dalam membantu memperbaiki luaran fungsional maupun mengurangi durasi rawat inap pasien stroke iskemik akut. Penelitian lebih lanjut dengan intervensi dan pengamatan yang lebih lama hingga fase kronik (selama 3-6 bulan) perlu untuk dilakukan.


Keywords


asam folat; durasi rawat inap; luaran fungsional; stroke iskemik akut

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References

Abid, N., Khan, S.A., dan Taseer, I.U.H., 2012. Frequency of Hyperlipidemia in Patients Presenting with Ischemic Stroke. Pakistan Journal of Medical and Health Sciences, 6: 423–428.

Adams, H.P.Jr., Davis, P.H., Leira, E.C., Chang, K.C., Bendixen, B.H., Clarke, W.R., dkk., 1999. Baseline NIH Stroke Scale Score Strongly Predicts Outcome After Stroke: A Report of The Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology, 53: 126–131.

Aguila, N.P.T., Carrera, C., Muiño, E., Cullell, N., Cárcel-Márquez, J., Gallego-Fabrega, C., dkk., 2019. Clinical Variables and Genetic Risk Factors Associated with the Acute Outcome of Ischemic Stroke: A Systematic Review. Journal of Stroke, 21: 276–289.

Appelros, P., Stegmayr, B., dan Terént, A., 2009. Sex Differences in Stroke Epidemiology: A Systematic Review. Stroke, 40: 1082–1090.

Aulia, D., Ayu, S.F., dan Nefonafratilova, N., 2017. Analisis Perbandingan Biaya Langsung (Direct Cost) dan Biaya Tidak Langsung (Indirect Cost) pada Pasien Stroke Di Rumah Sakit. Jurnal Ekonomi Kesehatan Indonesia, 2: 82–88.

Bhaskar, S., Stanwell, P., Bivard, A., Spratt, N., Walker, R., Kitsos, G.H., dkk., 2017. The Influence of Initial Stroke Severity On Mortality, Overall Functional Outcome and In-Hospital Placement at 90 Days Following Acute Ischemic Stroke: A Tertiary Hospital Stroke Register Study. Neurology India, 13: 1252–1259.

Breekveldt-Postma, N.S., Penning-van Beest, F.J.A., Siiskonen, S.J., Falvey, H., Vincze, G., Klungel, O.H., dkk., 2008. The Effect of Discontinuation of Antihypertensives on The Risk of Acute Myocardial Infarction and Stroke. Current Medical Research and Opinion, 24: 121–127.

Chang, K.-C., Tseng, M.-C., Weng, H.-H., Lin, Y.-H., Liou, C.-W., dan Tan, T.-Y., 2002. Prediction of Length of Stay of First-Ever Ischemic Stroke. Stroke, 33: 2670–2674.

Cholesterol Treatment Trialists’ (CTT) Collaborator, 2005. 2005 Efficacy and Safety of Cholesterol Lowering Treatment: Prospective Meta-Analysis of Data from 90.056 Participants in 14 Randomised Trials of Statins. Lancet, 366: 1267–1278.

Homocysteine Lowering Trialists’ Collaboration, 2005. Dose-Dependent Effects of Folic Acid on Blood Concentrations of Homocysteine: A Meta-Analysis of The Randomized Trials. The American Journal of Clinical Nutrition, 82: 806–812.

Homocysteine Studies Collaboration, 2002. Homocysteine and Risk of Ischemic Heart Disease and Stroke: A Meta-analysis. JAMA, 288: 2015.

Hsu, C.-Y., Chiu, S.-W., Hong, K.-S., Saver, J.L., Wu, Y.-L., Lee, J.-D., dkk., 2018. Folic Acid in Stroke Prevention in Countries without Mandatory Folic Acid Food Fortification: A Meta-Analysis of Randomized Controlled Trials. Journal of Stroke, 20: 99–109.

Ikawati, Z., 2018. Tatalaksana Terapi Penyakit Sistem Syaraf Pusat. Bursa Ilmu, Yogyakarta.

Jia, J., Wang, A., Wang, J., Wu, J., Yan, X., Zhou, Y., dkk., 2016. Homocysteine and Its Relationship to Asymptomatic Carotid Stenosis in a Chinese Community Population. Scientific Reports, 6: 37361.

Kamel, H., Okin, P.M., Elkind, M.S.V., dan Iadecola, C., 2016. Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model. Stroke, 47: 895–900.

Kemenkes RI, 2018. Hasil Utama Riskesdas 2018. Kemenkes RI, Jakarta.

Khoury, J.C., Kleindorfer, D., Alwell, K., Moomaw, C.J., Woo, D., Adeoye, O., dkk., 2013. Diabetes Mellitus: A Risk Factor for Ischemic Stroke in a Large Biracial Population. Stroke, 44: 1500–1504.

Lawes, C.M.M., Bennett, D.A., Feigin, V.L., dan Rodgers, A., 2004. Blood Pressure and Stroke: An Overview of Published Reviews. Stroke, 35: 776–785.

Ma, F., Wu, T., Zhao, J., Song, A., Liu, H., Xu, W., dkk., 2016. Folic Acid Supplementation Improves Cognitive Function By Reducing The Levels of Peripheral Inflammatory Cytokines in Elderly Chinese Subjects with MCI. Scientific Reports, 6: 37486.

Malouf, R., Grimley Evans, J., dan Areosa Sastre, A., 2008. Folic Acid With or Without Vitamin B12 for Cognition and Dementia, dalam: The Cochrane Collaboration (Ed.), The Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, Chichester, UK, hal. 1–29.

Markišić, M., Pavlović, A.M., dan Pavlović, D.M., 2017. The Impact of Homocysteine, Vitamin B12, and Vitamin D Levels on Functional Outcome after First-Ever Ischaemic Stroke. BioMed Research International, 2017: 1–6.

Martin-Schild, S. dan Samai, A., 2015. Sex Differences in Predictors of Ischemic Stroke: Current Perspectives. Vascular Health and Risk Management, 11: 427.

Menkes RI, 2018. Peraturan Menteri Kesehatan RI Nomor 54 Tahun 2018 Tentang Penyusunan Dan Penerapan Formularium Nasional Dalam Penyelenggaraan Program Jaminan Kesehatan. Kemenkes RI, Jakarta.

Obeid, R. dan Herrmann, W., 2006. Mechanisms of Homocysteine Neurotoxicity in Neurodegenerative Diseases With Special Reference to Dementia. Federation of European Biochemical Societies, 580: 2994–3005.

Pan, B., Jin, X., Jun, L., Qiu, S., Zheng, Q., dan Pan, M., 2019. The Relationship Between Smoking and Stroke: A Meta-Analysis. Medicine, 98: e14872.

PERDOSSI, 2011. Guideline Stroke Tahun 2011 1–132.

Pinzon, R. dan Asanti, L., 2010. AWAS STROKE! Pengertian, Gejala, Tindakan, Perawatan, Dan Pencegahan. Penerbit Andi, Yogyakarta.

Rasyid, A. dan Soertidewi, L., 2007. Unit Stroke: Manajemen Stroke Secara Komprehensif. Balai Penerbit Fakultas Kedokteran Indonesia, Jakarta.

Roza, R., 2010. Lama Hari Rawat Pasien Stroke di RSCUPN Cipto Mangunkusumo dan Faktor-Faktor yang Mempengaruhi. CRID-TROPHID, Departement Neurology, Universitas Indonesia.

Setyopranoto, I., Bayuangga, H.F., Panggabean, A.S., Alifaningdyah, S., Lazuardi, L., Dewi, F.S.T., dkk., 2019. Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia. Stroke Research and Treatment, 2019: 1–8.

Soliman, R.H., Oraby, M.I., Fathy, M., dan Essam, A.M., 2018. Risk Factors of Acute Ischemic Stroke in Patients Presented to Beni-Suef University Hospital: Prevalence and Relation to Stroke Severity at Presentation. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 54: 1–9.

Son, M.K., Lim, N.-K., Kim, H.W., dan Park, H.-Y., 2017. Risk of Ischemic Stroke After Atrial Fibrillation Diagnosis: A National Sample Cohort. PLoS ONE, 12: 13.

Tian, T., Yang, K.-Q., Cui, J.-G., Zhou, L.-L., dan Zhou, X.-L., 2017. Folic Acid Supplementation for Stroke Prevention in Patients With Cardiovascular Disease. Am J Med Sci, 354: 379–387.

Toole, F.J., Malinow, M.R., dan Chambless, L.E., 2004. Lowering Homocysteine in Patients with Ischemic Stroke to Prevent Recurrent Stroke, Myocardial Infarction, and Death. The Vitamin Intervention for Stroke Prevention (VISP) Randomized Controlled Trial. ACC Current Journal Review, 13: 20–21.

Wang, L., Cui, W., Nan, G., dan Yu, Y., 2015. Meta-Analysis Reveals Protective Effects of Vitamin B on Stroke Patients. Translational Neuroscience, 6: 150–156.

Wang, X., Qin, X., Demirtas, H., Li, J., Mao, G., Huo, Y., dkk., 2007. Efficacy of Folic Acid Supplementation in Stroke Prevention: A Meta-Analysis. The Lancet, 369: 1876–1882.

Yu, J.-G., Zhou, R.-R., dan Cai, G.-J., 2011. From Hypertension to Stroke: Mechanisms and Potential Prevention Strategies: Hypertension and Stroke Prevention. CNS Neuroscience & Therapeutics, 17: 577–584.

Yuan, M., Wang, B., dan Tan, S., 2018. Mecobalamin and Early Functional Outcomes of Ischemic Stroke Patients With H-Type Hypertension. REV ASSOC MED BRAS, 64: 428–432.

Yukawa, M., Naka, H., Murata, Y., Katayama, S., Kohriyama, T., Mimori, Y., dkk., 2001. Folic Acid-Responsive Neurological Diseases in Japan. Journal of Nutritional Science and Vitaminology, 47: 181–187.

Zhong, C., Lv, L., Liu, C., Zhao, L., Zhou, M., Sun, W., dkk., 2014. High Homocysteine and Blood Pressure Related to Poor Outcome of Acute Ischemia Stroke in Chinese Population. PLoS ONE, 9: e107498.



DOI: https://doi.org/10.22146/farmaseutik.v18i3.66230

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