Peran Potensial N-Asetilsistein dalam Penatalaksanaan Stroke Iskemik Akut: Sebuah Tinjauan Sistematis: The Potential Role of N-Acetylcysteine in Treatment of Acute Ischemic Stroke: A Systematic Review

Janaari Pramana Putri Gelgel; Luh Kadek Trisna Lestari; I Putu Dhidhi Pradnya Suryadiarsa

doi:10.35473/jhhs.v8i2.780

Authors

Janaari Pramana Putri Gelgel RSUD Bangli
Luh Kadek Trisna Lestari RSUD Bangli
I Putu Dhidhi Pradnya Suryadiarsa RS Ngoerah

DOI:

https://doi.org/10.35473/jhhs.v8i2.780

Keywords:

N-asetilsistein, Stroke Iskemik Akut, Stres Oksidatif, Tinjauan Sistematis, Terapi Adjuvan

Abstract

Stroke is the second leading cause of death and a major cause of disability worldwide; oxidative stress and inflammation are key pathophysiological mechanisms in acute ischemic stroke that worsen neuronal injury and clinical outcomes. N-acetylcysteine (NAC), a glutathione precursor with antioxidant, anti-inflammatory, and thrombolytic properties, is considered a promising adjuvant therapy. This review aimed to summarize evidence on NAC’s efficacy and safety in acute ischemic stroke, following PRISMA 2020 and searching PubMed/MEDLINE, Cochrane Library, ScienceDirect, and ProQuest up to September 2025, supplemented by Google Scholar; eligible studies involved adult patients receiving NAC, alone or combined, with reported clinical outcomes or oxidative biomarkers. Of 618 articles identified, four studies (194 patients) met the inclusion criteria. NAC consistently improved NIHSS scores and 90-day modified Rankin Scale outcomes (p<0.05), while reducing oxidative biomarkers such as MDA, neopterin, and total oxidant status (p<0.05), alongside increases in total antioxidant capacity, SOD, and GPx (p<0.001); one study reported an 82% reduction in von Willebrand Factor multimers (p<0.001), although one trial found no significant difference in long-term mRS outcomes (p=0.85). NAC was generally well tolerated, though two fatal intracerebral hemorrhages occurred in patients with prior antiplatelet use. Current evidence remains limited, warranting large multicenter randomized trials.

ABSTRAK

Stroke merupakan penyebab kematian kedua dan penyebab utama disabilitas secara global; stres oksidatif dan inflamasi menjadi mekanisme patofisiologis kunci pada stroke iskemik akut yang memperberat kerusakan neuron dan memperburuk luaran klinis. N-asetilsistein (NAC), sebagai prekursor glutation, memiliki aktivitas antioksidan, antiinflamasi, dan potensi trombolitik sehingga dipertimbangkan sebagai terapi adjuvan yang menjanjikan. Tinjauan sistematis ini bertujuan merangkum bukti efektivitas dan keamanan NAC pada stroke iskemik akut, mengikuti pedoman PRISMA 2020 dengan penelusuran PubMed/MEDLINE, Cochrane Library, ScienceDirect, dan ProQuest hingga September 2025 serta pencarian manual via Google Scholar; studi diinklusi bila melibatkan pasien dewasa penerima NAC (monoterapi/kombinasi) dengan laporan luaran klinis atau biomarker oksidatif. Dari 618 artikel yang teridentifikasi, empat studi dengan 194 pasien memenuhi kriteria inklusi. NAC secara konsisten memperbaiki skor NIHSS dan modified Rankin Scale hari ke-90 (p<0,05), serta menurunkan biomarker oksidatif MDA, neopterin, dan total oxidant status (p<0,05) disertai peningkatan kapasitas antioksidan total, SOD, dan GPx (p<0,001); satu studi melaporkan penurunan multimer von Willebrand Factor 82% (p<0,001), meski satu uji klinis tidak menemukan perbedaan mRS jangka panjang (p=0,85). NAC umumnya ditoleransi baik, meski dua kasus perdarahan intraserebral fatal tercatat pada pasien dengan riwayat antiplatelet. Bukti yang tersedia masih terbatas sehingga diperlukan uji klinis acak terkontrol multisenter berskala besar.

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