Boleh ke tak?

"Okey..wad 6C - ada tak x-ray yang perlu ditengok ?..tak nak pulak nanti tiba-tiba ada yang kena review x-ray"

"Hmm..setakat ni takde lagi dr. Kem..ada sorang je yang baru pergi ke kat x-ray department. Esok sajalah kita review"

"then..semua orang , rounds to your own wards. Dr Fir akan rounds kat 6C..okey..cepat - cepat..go back to your own wards" jerit Dr Kem

Kami bergegas kembali ke wad masing-masing selepas arahan diberi.

"Staff nurse!..Ward round sekarang..Dr Fir akan buat rounds kat sini"

"kita start dengan Makcik Nira ..bilik 10"

"This is madam Nira, post right knee replacement, day 5. She has ambulated with walking frame already. However, we're still keeping her since there is an erythema surrounding the wound." Dr Sekinah presented

"Hmm..she's on what antibiotics right now?"

"IV rocephine , day 4 already. The erythema isn't progressing, same like yesterday, thus we plan her to keep her still and continue the iv antibiotics."

"okay..observe the wound first. Make sure she's ambulating."

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" Madam XI LI, post skin graft, day 6, yesterday already inspected the wound. The uptake is good, no necrotic tissue"

" Madam Maria,..she has multiple medical problems. Her ortho problem is right intertrochanteric fracture. She is on skin traction currently. She is able to flex and extend the ankle joint and the toes. " reported Dr helina

..."Hmm...i think she'll probably be managed conservatively..with her condition, i don't know whether she's a suitable candidate to undergo an operation. ..Okay..we'll discuss with the specialist first..make sure she's on anticoagulants..one of you need to discuss regarding which anticoagulant she wants.." Dr fir gave us the usual orders...


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" Syukur kali ni ward round dengan dr fir..tak de lah kena marah" Helina tersenyum

" Betul..dah lah cepat kali ni habis rounds..yay! boleh balik awal.." balas Julia

Aku meneruskan kerja aku..cuba menaip secepat mungkin progress patients selepas rounds..

Alamak..kena counselling patient regarding anticoagulant pulak..getus hatiku..

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Apakah itu anticoagulant..

An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting

Untuk patients yang akan bedridden for a long time - maksudnya , dia tidak akan berjalan sangat dan most of the time akan berada atas katil..ada risk of Deep vein thrombosis dan ia merupakan keadaan yang serius dimana boleh menyebabkan pulmonary embolism. Keadaan ini sangat membahayakan dan menyebabkan pesakit tu boleh meninggal dengan keadaan mengejut.

Sebagai pencegah kepada keadaan ini, kita menggunakan sejenis ubat yang dipanggil anticoagulant.

Yang menjadi isu nya ialah, anticoagulant yang di offer di hospital ialah samada heparin atau clexane.

Secara saintifiknya dua bahan ini berbeza dari segi molekular level. Tapi,untuk pesakit, yang menjadi isunya ialah sumber ubat-ubatan ini.

1) Clexane:

Enoxaparin is a low molecular weight heparin marketed as Lovenox or Clexane. It is used to prevent and treat deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection (by a health care provider or the patient). Its use is evolving in acute coronary syndromes (ACS).

Enoxaparin is manufactured by Sanofi-Aventis and is derived from the intestinal mucosa of pigs.

Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.

2)heparin

Heparin binds to the enzyme inhibitor antithrombin (AT) causing a conformational change that results in its activation through an increase in the flexibility of its reactive site loop.^[15] The activated AT then inactivates thrombin and other proteases involved in blood clotting, most notably factor Xa. The rate of inactivation of these proteases by AT can increase by up to 1000-fold due to the binding of heparin.^[16]

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" Assalamualaikum makcik..saya dr azhani..ni anak makcik ke?" aku menoleh ke arah seorang gadis di sebelah makcik tu. Dia mengangguk

" Makcik, keadaan makcik sekarang tidak mengizinkan untuk kita teruskan dengan operation, mungkin makcik kena pakai "skin traction" ini untuk beberapa waktu" aku menunjukkan ke arah skin traction yang terbalut pada kaki kanannya.

" Tapi, bila memakai skin traction ni, makcik akan berada atas katil saja untuk sementara waktu ni. tak boleh berjalan..makcik faham ke?"

Makcik Maria terdiam. Dia menghela nafas panjang. "ya..makcik faham"

aku menjelaskan komplikasi apabila patients terbaring lama atas katil dan keadaan Deep vein thrombosis. Dan akhirnya aku masuk pada isu anticoagulant.

"Tapi doktor rasa macamana..doktor pun muslim jugak..doktor syorkan ke guna yang dari bahan yang haram tu?"

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Hmm...apakah fatwa terhadap ubatan2 sebegini?