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SKRIPSI
KHILMI ABDUL RAHMAN
STUDI PENGGUNAAN KLOPIDOGREL PADA
PASIEN INFARK MIOKARD AKUT di RSUD
SIDOARJO
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2015
ii
Lembar Pengesahan
STUDI PENGGUNAAN KLOPIDOGREL PADA
PASIEN INFARK MIOKARD AKUT di RSUD
SIDOARJO
SKRIPSI
Dibuat Untuk Memenuhi Syarat Mencapai Gelar Sarjana Farmasi Pada
Program Studi Farmasi Fakultas Ilmu Kesehatan
Universitas Muhammadiyah Malang
2015
Oleh:
Khilmi Abdul Rahman
201110410311134
Disetujui Oleh:
Pembimbing I Pembimbing II
Drs. Didik Hasmono, M.S., Apt Hidajah Rachmawati, S.Si., Apt., Sp.FRS
NIP 1195809111986011001 NIP UMM. 11406090449
iii
Lembar Pengujian
STUDI PENGGUNAAN KLOPIDOGREL PADA
PASIEN INFARK MIOKARD AKUT di RSUD
SIDOARJO
SKRIPSI
Telah diuji dan dipertahankan di depan tim penguji Pada tanggal
Oleh:
Khilmi Abdul Rahman
201110410311134
Tim Penguji:
Penguji I Penguji II
Drs. Didik Hasmono, M.S., Apt Hidadjah Rachmawati, S.Si., Apt., Sp.FRS
NIP 1195809111986011001 NIP UMM. 11406090449
Penguji III Penguji IV
Dra Lilik Yusetyani., Apt.,Sp.FRS Ika Ratna Hidayati, Apt., M.Sc
NIDN 0727118602 NIP UMM. 11209070480
iv
KATA PENGANTAR
Syukur Alhamdulillah dan terimakasih penulis panjatkan kepada Allah
SWT atas rahmat dan hidayah-Nya sehingga penulis dapat menyelesaikan skripsi
yang berjudul “STUDI PENGGUNAAN KLOPIDOGREL PADA PASIEN
INFARK MIOKARD AKUT DI RSUD SIDOARJO” untuk memenuhi salah
satu persyaratan akademik dalam menyelesaikan Program Sarjana Farmasi
Fakultas Ilmu Kesehatan Universitas Muhammadiyah Malang.
Dalam proses penyusunan skripsi ini penulis tidak terlepas dari berbagai
pihak yang memberikan bimbingan, bantuan serta doa sehingga penulis dapat
menyelesaikannya dengan baik. Untuk itu penulis menyampaikan rasa terima
kasih yang sebesar-besarnya kepada:
1. Yoyok Bekti Prasetyo, M.Kep., Sp. Kom., selaku Dekan Fakultas Ilmu
Kesehatan Universitas Muhammadiyah Malang.
2. Dr. Atok Irawan, Sp.P, selaku Direktur RSUD Sidoarjo yang telah
memberikan izin untuk melaksanakan penelitian di RSUD Sidoarjo.
3. Nailis Syifa’, S.Farm,. Apt,. M.Sc. selaku Ketua Program Studi Farmasi
Universitas Muhammadiyah Malang.
4. Drs. Didik Hasmono, M.S., Apt sebagai Pembimbing I dan Hidajah
Rachmawati, S.Si., Apt., Sp.FRS sebagai Pembimbing II yang dengan
tulus ikhlas dan penuh kesabaran, membimbing dan selalu meluangkan
waktu maupun dorongan moral, memberi arahan-arahan terbaik kepada
saya sehingga skripsi ini dapat diselesaikan dengan baik.
5. Nailis Syifa’, S.Farm., Apt., M.Sc, Ika Ratna Hidayati, Apt., M.Sc dan
Dra.Lilik Yusetyani, Apt.,Sp.FRS sebagai Tim Penguji yang memberikan
saran, masukan, dan kritik yang membangun terhadap skripsi yang telah
saya kerjakan.
6. Program Studi Farmasi beserta seluruh staf pengajar Program Studi
Farmasi Universitas Muhammadiyah Malang yang telah mendidik dan
mengajarkan ilmu pengetahuan selama saya mengikuti program sarjana.
7. Heru Prabowo, S.Farm., Apt sebagai mantan Dosen Wali yang telah
memberikan bimbingan, arahan dan nasehat selama mengikuti pendidikan
di Program Studi Farmasi Universitas Muhammadiyah Malang.
v
8. Sendi Aulia Yunita, S.Farm., Apt., selaku Sekretaris Program Studi yang
telah melancarkan proses jalannya skripsi.
9. Bapak tersayang Abdul Munif, Ibu tersayang Masriyah, kakak perempuan
saya Nuratik Rachmania, kakak ipar saya Fachturozi, si kecil Ubay dan
segenap keluarga bani Akhiyak dan bani Royyan. Terimakasih yang
sebesar-besarnya atas doa tulus ikhlas, kasih sayang, perjuangan, nasehat,
kesabaran, dukungan moral maupun materi. Saya akan terus berusaha
dengan keras untuk membuat kalian bahagia dan bangga.
10. Teman-teman skripsi Klinis ahli IMA tersayang: Arin, Lili, Andin,
Faradila, Huda. Terimakasih sudah selalu membantu dalam mengerjakan
skripsi, menemani dalam segala kesusahan maupun kebahagiaan yang kita
lalui selama proses pengerjaan skripsi.
11. Teman-teman Program Studi Farmasi khususnya keluarga Farmasi C
2011: Adel pampam, Luluk darjo, Anggi maumere, Putri incess, Adisya
rapunzel, Afnan endut, Resti ijo, Fina bentol, Yayak, Tante della, Windi
budi, Inna, Kaka ceyi, Mak hiru, Roura, Tukik, Ilham, Irfan, Izhu, Hasby,
Abi, Mbak Sulis, Mbak Nining, Ferin, Reni, Sinta, Yuli, Rara.
Terimakasih sudah menjadi keluarga terdekat selama saya menuntut ilmu,
melewati suka dan duka bersama.
12. Teman kontrakan ansol yang selalu menemani selama masa kuliah di
farmasi UMM dan bersama mengalami perjuangan menggapai cita – cita.
13. Untuk teman – teman SMA maupun teman kampung: babel, widya, uuk,
anggi, sidiq, robi, fuad, kirun, amir dan lainya yang tidak bisa sebutkan
satu persatu terimakasih telah memberikan dukungannya.
14. Temanku Robiana Prihandini. Terimakasih telah menjadi seseorang yang
mau menyemangatiku, mendoakanku, dan menemaniku menyelesaikan
skripsi, semoga kita selalu bertemu dalam doa.
15. Semua pihak yang tidak dapat disebutkan satu-persatu, terimakasih atas
bantuan, dukungan, semangat, dan doa yang telah diberikan dalam
penyelesaian skripsi ini.
vi
Akhir kata, semoga Allah S.W.T. membalas kebaikan Bapak, Ibu, dan
Saudara sekalian. Semoga skripsi ini dapat memberikan sumbangan bagi
perkembangan ilmu pengetahuan dan kita semua. Amin. Terimakasih .
Malang, 19 Agustus 2015
Khilmi Abdul Rahman
vii
DAFTAR ISI
Tabel Halaman
HALAMAN JUDUL ............................................................................................ i
LEMBAR PENGESAHAN ................................................................................ ii
LEMBAR PENGUJIAN .................................................................................... iii
KATA PENGANTAR ....................................................................................... iv
RINGKASAN ..................................................................................................... v
ABSTRAK ......................................................................................................... vi
DAFTAR ISI .................................................................................................... viii
DAFTAR GAMBAR DAN TABEL ................................................................. xv
DAFTAR LAMPIRAN .................................................................................... xvi
DAFTAR SINGKATAN ................................................................................ xvii
BAB I PENDAHULUAN ................................................................................... 1
1.1 Latar Belakang ........................................................................................ 1
1.2 Rumusan Masalah ................................................................................... 4
1.3 Tujuan Penelitian ..................................................................................... 4
1.3.1 Tujuan Umum ................................................................................ 4
1.3.2 Tujuan Khusus ............................................................................... 4
1.4 . Manfaat Penelitian…………………………..………………………….4
1.4.1 Manfaat Penelitian Bagi Rumah Sakit ........................................... 4
1.4.2 Manfaat Bagi Peneliti .................................................................... 4
BAB II TINJAUAN PUSTAKA ......................................................................... 5
2.1 Pengertian Infark Miokard Akut .............................................................. 5
2.2 Epidemiologi Infark Miokard Akut .......................................................... 5
2.3 Etiologi Infark Miokard Akut .................................................................. 6
2.4 Patofisiologi Infark Miokard Akut .......................................................... 6
2.5 Patogenesis Infark Miokard Akut ............................................................ 9
2.6 Manifestasi Klinis .................................................................................. 11
2.7 Klasifikasi Infark Miokard ................................................................... 13
2.7.1 Infark Miokard Secara Tiba – Tiba ............................................. 13
2.7.2 Infark Miokard Dengan Iskemik Yang Tidak Seimbang ............ 13
viii
2.7.3 Gagal Jantung Akibat Infark Miokard ......................................... 14
2.7.4 Infark Miokard Dengan Revaskularisasi ..................................... 14
2.8 Faktor Resiko ......................................................................................... 15
2.8.1 Aterosklerosis .............................................................................. 15
2.8.2 Diabetes Militus ........................................................................... 15
2.8.3 Hipertensi ..................................................................................... 16
2.8.4 Merokok ....................................................................................... 16
2.9 Diagnosis Infark Miokard ...................................................................... 16
2.9.1 Pemeriksaan Fisik ........................................................................ 16
2.9.2 Pemeriksaan Data Laboratorium ................................................. 18
2.9.2.1 Elektrokardigram .................................................................... 18
2.9.2.2 Serum Biomarker Jantung....................................................... 20
2.9.2.2.1 SGOT dan SGPT .......................................................... 20
2.9.2.2.2 Serum CK (Creatin Kinase) ......................................... 20
2.9.2.2.3 Serum CK-MB ............................................................. 21
2.9.2.2.4 Serum Troponin ........................................................... 22
2.9.2.3 Cardiac Imaging ...................................................................... 24
2.10 Komplikasi Infark Miokard ................................................................... 24
2.11 Penatalaksanaan Terapi Infark Miokard Akut....................................... 26
2.11.1 Terapi Farmakologi ..................................................................... 26
2.11.1.1 Oksigen ................................................................................ 27
2.11.1.2 Fibrinolitik ........................................................................... 27
2.11.1.3 Antiplatelet dan Antithrombin ............................................. 28
2.11.1.3.1 Terapi Antiplatelet Klopidogrel Pada Pasien IMA ...... 29
2.11.1.4 ACE-Inhibitor dan ARB ...................................................... 31
2.11.1.5 Beta-Bloker .......................................................................... 32
2.11.1.6 Calsium Channel Bloker (CCB) .......................................... 33
2.11.1.7 Statin .................................................................................... 33
2.11.1.8 Nitrate .................................................................................. 34
2.11.1.9 Glikoprotein IIa/IIIb ............................................................. 34
2.11.2 Terapi Non-Farmakologi ............................................................. 34
ix
BAB III KERANGKA KONSEPTUAL ........................................................... 36
3.1 Uraian Kerangka Konseptual ................................................................ 36
3.2 Bagan Alir Kerangka Konseptual Pada Pasien IMA ............................. 37
3.3 Kerangka Operasional Terapi Pada Pasien IMA ................................... 38
BAB IV METODE PENELITIAN ................................................................... 39
4.1 Rancangan Penelitian ............................................................................. 39
4.2 Populasi dan Sampel .............................................................................. 39
4.2.1 Populasi ............................................................................................ 39
4.2.2 Sampel .............................................................................................. 39
4.2.4 Kriteria Data Inklusi ........................................................................ 39
4.2.3 Kriteria Data Ekslusi ........................................................................ 40
4.3 Bahan Penelitian .................................................................................... 40
4.4 Instrumen Penelitian .............................................................................. 40
4.5 Tempat dan Waktu Penelitian ............................................................... 40
4.6 Definisi Operasional .............................................................................. 40
4.7 Metode Pengumpulan Data ................................................................... 41
4.8 Analisis Data ......................................................................................... 42
BAB V HASIL PENELITIAN ......................................................................... 43
5.1 Jenis Kelamin ........................................................................................ 43
5.2 Umur ...................................................................................................... 44
5.3 Status pasien .......................................................................................... 44
5.4 Faktor Resiko ........................................................................................ 44
5.5 Penggunaan Obat Pada Pasien Infak Miokard Akut ............................. 46
5.6 Penggunaan Klopidogrel Pada Pasien IMA .......................................... 49
5.6.1 Pola Terapi Klopidogrel Pada Pasien IMA ...................................... 49
5.6.2 Pola Penggunaan Antiplatelet Kombinasi Pada Pasien IMA .......... 49
5.6.3 Pola Pergantian Dosis Antiplatelet Pada Pasien IMA ..................... 50
5.7 Lama Penggunaan Klopidogrel Pada 43 Pasien IMA ........................... 50
5.8 Lama Perawatan Pada Pasien IMA di Rumah Sakit ............................. 51
5.9 Keadaan Keluar Rumah Sakit (KRS) .................................................... 51
BAB VI PEMBAHASAN ................................................................................. 52
BAB VII KESIMPULAN DAN SARAN ......................................................... 63
x
6.1 Kesimpulan ............................................................................................ 63
6.2 Saran ...................................................................................................... 63
xi
DAFTAR GAMBAR DAN TABEL
Gambar Halaman
2.1 Patofisiologi Infark Miokard Akut. ................................................................... 7
2.2 Proses Terjadinya Ateroma . ........................................................................... 10
2.3 Klasifikasi Infark Miokard Akut. .................................................................... 14
2.4 Evaluasi EKG Infark Miokard Akut. ............................................................. 19
2.5 Grafik Biomarker CK-MB Dan Troponin…………........................................21
2.6 Terapi Farmakologi………………………………..........................................26
2.7 Struktur Kimia Klopidogrel ............................................................................ 29
5.1 Diagram Presentase Distribusi Jenis Kelamin Pada 43 Pasien IMA. ............. 44
5.2 Diagram Presentase Umur Pada 43 Pasien IMA………….............................44
5.3 Diagram Presentase Demografi Status Pada 43 Pasien IMA...........................45
5.4 Diagram Presentase Demografi Faktor Resiko Pada 43 Pasien IMA ............. 45
5.5 Diagram Distribusi Lama Perawatan Pada 43 Pasien IMA ............................ 51
5.6 Diagram Distribusi Kondisi Pada 43 Pasien IMA Saat KRS .......................... 51
Tabel Halaman
2.1 Evaluasi Biomarker Pasien STEMI. ............................................................... 23
2.2 Sediaan Klopidogrel di Indonesia. .................................................................. 30
2.3 Interaksi Klopidogrel. ..................................................................................... 31
5.1 Pola Penggunaan Berdasarkan Golongan Terapi Pada Pasien IMA. .............. 46
5.2 Pola Penggunaan Terapi Pada Pasien IMA. .................................................... 47
5.3 Pola Penggunaan Terapi Penyerta Pada Pasien IMA. ..................................... 48
5.4 Pola Penggunaan Klopidogrel Pada Pasien IMA. ........................................... 49
5.5 Pola Penggunaan Kombinasi Pada Pasien IMA.............................................. 49
5.6 Pola Pergantian Dosis Antiplatelet Pada Pasien IMA..................................... 50
5.7 Lama Penggunaan Klopidogrel Pada Pasien IMA .......................................... 50
xii
DAFTAR LAMPIRAN
Lampiran Halaman
1. Daftar Riwayat Hidup...............................................................................69
2. Surat Pernyataan Bebas Plagiasi................................................................70
3. Keterangan Kelayakan Etik …………………………………………......71
4. Daftar Nilai Normal……………………………………………………...73
xiii
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