7UN.DUGL\RO'HUQ$Uü$UFK7XUN6RF&DUGLROGRLWNGD
<HQLRUDODQWLNRDJODQYHDQWLDJUHJDQLODoODU×NXOODQDQKDVWDODUGD
SHULRSHUDWLI\DNODü×P
3HULRSHUDWLYHPDQDJHPHQWLQSDWLHQWVUHFHLYLQJQHZHURUDODQWLFRDJXODQW
DQGDQWLDJJUHJDQWDJHQWV
úVWDQEXOhQLYHUVLWHVL&HUUDKSDüD7×S)DNOWHVL.DUGL\RORML$QDELOLP'DO×úVWDQEXO
'U%LOJHKDQ.DUDGDù'U%DU×üúNLWLPXU'U=HNLgQJHQ
Özet–<HQLQHVLODQWLDJUHJDQYHDQWLNRDJODQLODoNXOODQDQ
YHFHUUDKLLüOHPJHoLUPHVLJHUHNHQKDVWDVD\×ODU×Q×QJLGHUHN
DUWPDV× EHNOHQPHNWHGLU (OLPL]GH EX KDVWDODUGD HQ X\JXQ
\DNODü×P×QQHROGXùXLOHLOLüNLOLEDüNDDPDoODUODWDVDUODQP×ü
oDO×üPDODU×QDOWJUXSLQFHOHPHOHULQGHQHOGHHGLOPLüN×V×WO×VD-
\×GDYHULOHUEXOXQPDNWDG×U%X\NVHNULVNOLKDVWDJUXEXQGD
FHUUDKLJLULüLPOHULQJYHQOH\DS×ODELOPHVLLoLQNOLQLNoDO×üPD- ODUDDFLOLKWL\DoGX\XOPDNWDG×U'DELJDWUDQYHULYDURNVDEDQ×Q
YDUIDULQGHQ IDUNO× RODUDN K×]O× EDüODQJ×oO× YH N×VD \DU×ODQPD
|PUQHVDKLS|QJ|UOHELOLUYHLVWLNUDUO×DQWLNRDJODQHWNLOHUL
ROGXùXQGDQ EX LODoODU×Q HWNLOHULQL GHùHUOHQGLUPH DPDF×\OD
UXWLQODERUDWXYDULQFHOHPHVLQHJHUHNVLQLPGX\XOPDPDNWDG×U
%XLODoODU×QIDUPDNRORMLN|]HOOLNOHULSHULRSHUDWLIG|QHPGHRUDO
DQWLNRDJODQ×Q DQWLWURPERWLN HWNLVL ROPDGDQ JHoHQ ]DPDQ×
HQD]DLQGLUHELOPHRODQDù×Q×VDùODPDNWDG×U%XLODoODU×QK×]O×
HWNLOHULYHN×VD\DU×ODQPD|PUOHULQHGHQL\OHSHULRSHUDWLIG|- QHPGHKHSDULQOHN|SUOHPH\DSPDJHUHNVLQLPLQLD]DOWDELOH- FHNOHULEHONLGHRUWDGDQNDOG×UDELOHFHNOHUL|QJ|UOPHNWHGLU
Summary– ,W LV DQWLFLSDWHG WKDW DQ LQFUHDVLQJ QXPEHU
RI SDWLHQWV XQGHUJRLQJ VXUJLFDO SURFHGXUHV ZLOO EH WDNLQJ
QHZ DQWLFRDJXODQWV DQG DQWLDJJUHJDQWV &XUUHQWO\ RQO\ D
VPDOODPRXQWRIGDWDZKLFKZHUHGHULYHGIURPVXEJURXS
DQDO\VHVRIXQGHGLFDWHGVWXGLHVH[LVWUHJDUGLQJWKHRSWL- PDOVWUDWHJ\LQWKHVHSDWLHQWV&OLQLFDOVWXGLHVDUHXUJHQWO\
UHTXLUHGWRHVWDEOLVKVDIHVXUJLFDOSURFHGXUHVIRUWKLVKLJK
ULVNSDWLHQWSRSXODWLRQ8QOLNHZDUIDULQGDELJDWUDQDQGUL- YDUR[DEDQ KDYH SUHGLFWDEOH DQG FRQVLVWHQW DQWLFRDJXODQW
HIIHFWVZLWKDUDSLGRQVHWRIDFWLRQVKRUWKDOIOLIHDQGFRQ- VHTXHQWO\QRQHHGIRUURXWLQHODERUDWRU\WHVWLQJ7KHSKDU- PDFRORJLFSURÀOHVRIWKHVHGUXJVUHSUHVHQWDQDGYDQWDJH
IRU SDWLHQWV RQ FKURQLF RUDO DQWLFRDJXODQW WUHDWPHQW ZKR
DUHXQGHUJRLQJLQYDVLYHSURFHGXUHV7KHVHGUXJVPD\PL- QLPL]HSDWLHQWWLPHVSHQWZLWKRXWWKHDQWLWKURPERWLFHIIHFWV
RIRUDODQWLFRDJXODQWVGXULQJWKHSHULRSHUDWLYHSHULRGSR- WHQWLDOO\HOLPLQDWLQJWKHQHHGIRUEULGJLQJWKHUDS\DOWRJHW- KHU
548
LWDPLQ . DQWDJRQLVWOHULQGHQ IDUNOÕ RODUDN
\HQL NXOODQÕOPD\D EDúODQDQ GDELJDWUDQ ULYD- URNVDEDQYHDSLNVDEDQJLELJQFHORUDODQWLNRDJODQ
LODoODUÕQKÕ]OÕHWNLOHULYHNÕVD\DUÕODQPD|PUOHULQH- GHQL\OH SHULRSHUDWLI G|QHPGH KHSDULQOH N|SUOHPH
\DSPD JHUHNVLQLPLQL D]DOWDELOHFHNOHUL EHONL GH RU- WDGDQ NDOGÕUDELOHFHNOHUL |QJ|UOPHNWHGLU<HQL DQWL- NRDJODQODUÕQ\DQÕVÕUDVRQ\ÕOODUGDNORSLGRJUHOHHN
RODUDNWLNDJUHORUYHSUDVXJUHOJLEL\HQLDQWLDJUHJDQ- ODUGDJQONX\JXODPDGDNXOODQÕOPD\DEDúODQPÕúWÕU
%XLODoODUÕQ\D\JÕQNXOODQÕPÕQÕQSHULRSHUDWLIDQWLNRD- JODQLODoX\JXODPDVWUDWHMLOHULQLGH÷LúWLUHFH÷L|QJ|- UOPHNWHGLU3UDVXJUHOYHGDELJDWUDQJLELLNL\HQLDMDQ
\DNÕQ]DPDQGDONHPL]GHGHNXOODQÕPDVXQXOPXúWXU
%X LODoODUÕQ NXOODQÕ- PÕQÕQ JLGHUHN DUWPD- VÕQD NDUúÕQ SHULRSH- UDWLI NXOODQÕPODUÕ LOH
LOLúNLOL D\UÕQWÕOÕ ELOJL
FHUUDKL |QFHVL GH÷HUOHQGLUPH NÕODYX]ODUÕQGD GD EX- OXQPDPDNWDGÕU $\UÕFD ONHPL]GH ED]Õ \HQL RUDO
DQWLNRDJODQ YH DQWLDJUHJDQ DMDQODU úX DQGD \D\JÕQ
NXOODQÕPGDROPDVDGDEXGXUXPXQ\DNÕQGDGH÷LúH- ELOHFH÷L \XUWGÕúÕQGDQ JHOHQ ED]Õ KDVWDODUÕQ EXQODUÕ
DOPDNWD RODELOHFH÷L GH DNOD JHOPHOLGLU %X QHGHQOH
FHUUDKLJLULúLP|QFHVL\HQLDQWLNRDJODQYHDQWLDJUH- JDQLODoODUÕQNHVLOPH]DPDQODUÕQÕQL\LELOLQPHVLJH- UHNPHNWHGLU7DEOR
>@V
.×VDOWPDODU'0$+ 'úNPROHNOD÷ÕUOÕNOÕKHSDULQ )'$ )RRGDQG'UXJ$GPLQLVWUDWLRQ 358 3<UHDNVL\RQQLWHVL
*HOLüWDULKL .DEXOWDULKL
<D]×üPDDGUHVL'U%DU×üúNLWLPXUúVWDQEXOhQLYHUVLWHVL&HUUDKSDüD7×S)DNOWHVL.DUGL\RORML$QDELOLP'DO×)DWLKúVWDQEXO
7HOHSRVWDLNLWLPXU#JPDLOFRP
7UN.DUGL\RORML'HUQHùL
2UDO YH\D LQWUDYHQ|] \ROOD NXOODQÕODQ WP DQWL- NRDJODQYHDQWLDJUHJDQLODoODUÕQVRQYHULOLúOHULQGHQ
LWLEDUHQ \DUÕODQPD |PUQQ LNL NDWÕ NDGDU ]DPDQ
JHoPHGHQ FHUUDKL JLULúLP \DSÕOPDVÕ SHULRSHUDWLI G|- QHPGHNDQDPDRODVÕOÕ÷ÕQÕDUWWÕUÕU
>@%XDMDQODUÕQFHU- UDKLJLULúLP|QFHVLQGHNHVLOPHVL|QHULOHQVUHOHU7DE- OR ¶GH J|VWHULOPLúWLU 9DUIDULQLQ EHOOL ELU \DUÕODQPD
|PUROPDGÕ÷ÕQGDQFHUUDKLJLULúLP]DPDQÕ,15G- ]H\LQHJ|UHEHOLUOHQPHNWHGLU
<HQL RUDO DQWLNRDJODQ LODoODUÕQ \DUÕODQPD |PU- OHULE|EUHNYH\DNDUDFL÷HULúOHYOHUL\OHLOLúNLOLRODUDN
SHULRSHUDWLI KDVWDODUGD FLGGL GH÷LúNHQOLNOHU J|VWHUH- ELOPHNWHGLU %X QHGHQOH EX LODoODU LoLQ |QHULOHQ ]D- PDQDUDOÕNODUÕ\DOQÕ]FDE|EUHNYHNDUDFL÷HULúOHYOHUL
QRUPDORODQKDVWDODULoLQJHoHUOLGLU
>@&HUUDKLJLULúLPLQ\HULYHNDQDPDULVNLG]H\LGH
SHULRSUHDWLIG|QHPGHDQWLNRDJODV\RQUHMLPLG]HQ-
OHQLUNHQGLNNDWHDOÕQPDOÕGÕU&HUUDKLNDQDPDULVNLQLQ
\DQÕVÕUDVSLQDOYHHSLGXUDODQHVWH]LJLELLúOHPOHULQGH
WDPELUKHPRVWDWLNIRQNVL\RQJHUHNWLUGL÷LXQXWXOPD- PDOÕGÕU.DQDPDULVNLYHKHPRVWD]GXUXPXFHUUDKLYH
DQHVWH]LHNLELLOHWDUWÕúÕOPDOÕJHUHNLUVHUXWLQX\JXOD- PDODUÕQGÕúÕQDoÕNÕOPDOÕYHKHUKDVWDLoLQ|]HOELUVWUD- WHMLL]OHQPHOLGLU+DVWDODUÕQULVN\DUDURUDQÕGLNNDWOLFH
KHVDSODQPDOÕ |QFHGHQ WDQÕPODQPÕú IRUPOOHULQ X\- JXODQPDVÕ\HULQHKHUKDVWDLoLQD\UÕSHULRSHUDWLILODo
G]HQOHPHVL\DSÕOPDOÕGÕU
<HQLDQWLDJUHJDQLODoODU×NXOODQDQ
KDVWDODUGD\DNODü×P
3<LQKLELW|UOHULDNXWNRURQHUVHQGURPODUSHU- NWDQ NRURQHU JLULúLPOHU YH DVSLULQ LQWROHUDQVÕ RODQ
KDVWDODUGD \D\JÕQ RODUDN NXOODQÕOPDNWDGÕU øON NXOOD- QÕPD JLUHQ WLNORGLSLQGHQ VRQUD GDKD \D\JÕQ RODUDN
NXOODQGÕ÷ÕPÕ] NORSLGRJUHOH HN RODUDN WLNDJUHORU YH
SUDVXJUHO GH JQON X\JXODPDGD \HU DOPD\D EDúOD- PÕúWÕU%XQODUGDQSUDVXJUHO\DNÕQ]DPDQGDONHPL]GH
GHNXOODQÕPDVXQXOPXúWXU+HUQHNDGDUVRQ]DPDQ- ODUGD ED]Õ VWHQWOHU LoLQ GDKD NÕVD VUHOL LODo NXOODQÕ- PÕQÕQGDJYHQOLRODELOHFH÷L|QHVUOPúVHGHLONH
RODUDNoÕSODNPHWDOVWHQW\HUOHúWLULOHQKDVWDODUGDHQD]
KDIWDLODoVDOÕQÕPOÕVWHQWNXOODQÕODQKDVWDODUGDLVH
D\LNLOLDQWLWURPERVLWWHGDYL|QHULOPHNWHGLU
>@øNLOL
DQWLWURPERVLWWHGDYLQLQEXVUHOHUGHQ|QFHNHVLOPHVL
VWHQWWURPER]XULVNLWDúÕPDNWDGÕU$NXWNRURQHUVHQG- URPJHoLUHQYH\DVWHQW\HUOHúWLULOHQKDVWDODUÕQ\DNOD- úÕN¶LQGHD\LoLQGHELUFHUUDKLJLULúLP\DSÕODFD÷Õ
|QJ|UOPHNWHGLU
>@<NVHNLVNHPLULVNLRODQKDVWDODU- GD UXWLQ X\JXODPDGD 3< LQKLELW|UOHUL FHUUDKLGHQ
\DNODúÕNELUKDIWD|QFHNHVLOPHNWHYHEXVUHLoLQGH
KDVWDODU ROXPVX] NDUGL\DN ROD\ODUD DoÕN EXOXQPDN- WDGÕUODU %X EHNOHPH VUHVLQGH KDVWDODUÕQ \DNODúÕN
¶XQXQWHNUDUOD\DQLVNHPLNROD\ODU\DúDGÕ÷ÕELOGL- ULOPLúWLU
>@øVNHPLNNRPSOLNDV\RQODUÕQRUWD\DoÕNPDVÕFHUUD- KL JLULúLPL GDKD GD JHFLNWLUPHNWH DFLO JLULúLPOHUGH
VRUXQ\DúDQPDNWDKDVWDQHGH\DWÕúVUHVLYHPDOL\HW
DUWPDNWDGÕU&HUUDKLJLULúLPOHU|QFHVLQGH3<LQKL- ELW|UOHULQLQNHVLOPHVLJHUHNWL÷LQGHVWHQWWURPER]XQX
|QOHPHNLoLQNDQÕWODQPÕúELUVHoHQHNGHEXOXQPDPDN- WDGÕU'úNPROHNOD÷ÕUOÕNOÕKHSDULQOHULQ'0$+ EX DPDoOD NXOODQÕOPDVÕQÕQ HWNLQOL÷LQL J|VWHUHQ YHUL
EXOXQPDPDNWDGÕUhVWHOLNKHSDULQLQNHVLOGLNWHQVRQ- UD WURPERVLW UHDNWLYLWHVLQL DUWWÕUÕS VWHQW WURPER]XQX
WHWLNOH\HELOHFH÷LGúQOPHNWHGLU
>@Tablo 1. $QWLKHPRVWDWLN LODoODU×Q FHUUDKL JLULüLP
|QFHVLQGHNHVLOPHVLJHUHNHQ]DPDQDUDO×NODU×
&HUUDKLJLULüLP|QFHVL
YHULOPHPHVLJHUHNHQVUH
8)+ VDDW
'0$+HQRNVDSDULQ VDDW )RQGDSDULQXNV VDDW
5LYDURNVDEDQ VDDW
$SLNVDEDQ VDDW
.XPDGLQ JQ,15
+LUXGLQ VDDWQRUPDOD377
$JUDWUREDQ VDDW
'DELJDWUDQ VDDW
.DQJUHORU VDDW
.ORSLGRJUHO JQ
7LNORGLSLQ JQ
3UDVXJUHO JQ
7LNDJUHORU JQ
6LODVWR]RO VDDW
$VSLULQ ²
$EVLNVLPDE VDDW
7LURÀEDQ VDDW
(SWLÀEDWLG VDDW
gQHULOHU QRUPDO E|EUHN YH NDUDFLùHU LüOHYOHUL RODQ KDVWDODU LoLQGLU
%|EUHNLüOHYER]XNOXùXRODQKDVWDODUGD|]HOOLNOHGDELJDWUDQWLURÀEDQ
YHHQRNVDSDULQJLELLODoODU×QHWNLQOLùLX]DPDNWDG×U
$VSLULQHWNLQOLùLJQHNDGDUVUPHVLQHNDUü×QFHUUDKLJLULüLPOHULQ
oRùXQGD|]HOOLNOHGüNGR]DVSLULQLQNHVLOPHVL|QHULOPH]
8)+8QIUDNVL\RQHKHSDULQ'0$+'üNPROHNODù×UO×NO×KHSDULQ
<HQLRUDODQWLNRDJODQYHDQWLDJUHJDQLODoODU×NXOODQDQKDVWDODUGDSHULRSHUDWLI\DNODü×P
7UN.DUGL\RO'HUQ$Uü
øNLOLDQWLWURPERVLWNXOODQDQYHFHUUDKLJLULúLP\D- SÕODFDNKDVWDODUD\DNODúÕPKDVWDQÕQWURPER]ULVNLYH
FHUUDKLJLULúLPLQNDQDPDULVNLLOHLOLúNLOLGLU+DVWDQÕQ
ULVNLQLQ WDQÕPODQPDVÕ YH VWUDWHMLQLQ EHOLUOHQHELOPHVL
LoLQNDUGL\RORJDQHVWH]LVWYHFHUUDKÕQELUOLNOHGH÷HU- OHQGLUPH\DSPDVÕ|QHPWDúÕPDNWDGÕU3HNoRNFHUUDKL
JLULúLPDVSLULQNXOODQÕOÕUNHQNDEXOHGLOHELOLUELUNDQD- PDULVNLLOH\DSÕODELOPHNWHGLU7URPERWLNNDUGL\RYDV- NOHUROD\ULVNL\NVHNRODQKDVWDODUÕQGúNYH\DRUWD
GHUHFHGH NDQDPD ULVNL RODQ FHUUDKL JLULúLPOHULQGH
FHUUDKODU LNLOL DQWLWURPERVLW WHGDYLVL DOWÕQGD JLULúLP
\DSPDNRQXVXQGDFHVDUHWOHQGLULOPHOLGLU.ORSLGRJUH- OLQDQWLWURPERVLWHWNLQOL÷LVDDWLoLQGHSUDVXJUHOYH
WLNDJUHORU¶XQLVHGDNLNDLoLQGHEDúODU$QWLWURPER- VLWHWNLQOLNOHULLODoNHVLOGLNWHQVRQUDNORSLGRJUHOLoLQ
JQ SUDVXJUHO LoLQ JQ YH WLNDJUHORU LoLQ
LVHJQGHYDPHGHU0DM|UFHUUDKL\DSÕODFDNKDV- WDODUGDNORSLGRJUHOLQJQSUDVXJUHOLQJQYHWL- NDJUHORUXQJQ|QFHNHVLOPHVL|QHULOPHNWHGLU
>@Bu DMDQODULoLQGH\DUÕ|PUHQNÕVDRODQDMDQWLNDJUHORU- GXU$QFDNDNXWNRURQHUVHQGURPOXKDVWDODUGDWLNDJ- UHORUXSUDVXJUHOLOHNDUúÕODúWÕUDQ3/$72oDOÕúPDVÕQGD
NRURQHUDQML\RJUD¿VRQUDVÕFHUUDKLUHYDVNODUL]DV\RQ
\DSÕODQ KDVWDGD FHUUDKL LOH LOLúNLOL PDM|U NDQD- PD RUDQODUÕQGD IDUNOÕOÕN J|]OHPOHQPHPLúWLU VÕUD- VÕ\OD¶HNDUúÕOÕNS
>@øYHGLFHUUDKL
JLULúLP \DSÕOPDVÕ JHUHNHQ GXUXPODUGD WURPERVLW
IRQNVL\RQWHVWLNORSLGRJUHOH]D\ÕI\DQÕWJ|VWHUL\RUVD
NORSLGRJUHONXOODQDQKDVWDODUJQGHQGDKD|QFHGH
FHUUDKL\H YHULOHELOLU %LUNDo KDIWD |QFH VWHQW \HUOHú- WLULOHQKDVWDODUGDROGX÷XJLELDQWLWURPERVLWWHGDYLQLQ
NHVLOPHVLQLQoRNULVNOLROGX÷XGXUXPODUGDFHUUDKL|Q- FHVL RUDO DQWLWURPERVLW WHGDYL NHVLOLS \DUÕ |PU NÕVD
RODQWLUR¿EDQ\DGDHSWL¿EDWLGJLELJOLNRSURWHLQ,,E
,,,DLQKLELW|UOHULLOHN|SUOHPH|QHULOPLúWLU7LUR¿EDQ
NHVLOGLNWHQVDDWVRQUDFHUUDKLJLULúLP\DSÕODELOH- FH÷L ED]Õ ROJXODUGD ELOGLULOPHVLQH NDUúÕQ EX VWUDWH- MLQLQ oDOÕúPDODUOD NDQÕWODQPDGÕ÷Õ XQXWXOPDPDOÕGÕU
>@
%5,'*(oDOÕúPDVÕQGDGDNLND\DUÕ|PURODQ
YH LQWUDYHQ|] X\JXODQDQ ELU 3< LQKLELW|U RODQ
NDQJUHORUFHUUDKLJLULúLP|QFHVLN|SUOHPHDPDFÕ\OD
NXOODQÕOPÕúWÕU
>@dDOÕúPDGDDNXWNRURQHUVHQGURPXQ- GD YH\D VWHQW \HUOHúWLULOPHVL VRQUDVÕQGD NORSLGRJUHO
JLELRUDO3<LQKLELW|UOHULNXOODQDQYHFHUUDKLUH- YDVNODUL]DV\RQ \DSÕODFDN KDVWD\D FHUUDKL JLUL- úLPGHQ HQ D] VDDW |QFH NDQJUHORU \D GD SODVHER
YHULOPLúWLU dDOÕúPDGD SHULRSHUDWLI G|QHPGH 3<
UHDNVL\RQQLWHVL358RODUDN|OoOHQWURPERVLWUH- DNWLYLWHVLNDQJUHORUDODQJUXSWDSODVHER\DJ|UHEHOLU-
JLQ RODUDN GDKD GúN RODUDN J|]OHPOHQPLúWLU VÕUD- VÕ\OD358¶HNDUúÕOÕNS
+HULNLJUXSDUDVÕQDPDM|UNDQDPDRUDQODUÕEHQ]HUNHQ
VÕUDVÕ\OD¶HNDUúÕOÕNS PLQ|U
NDQDPDNDQJUHORUJUXEXQGDVD\ÕVDORODUDNGDKDID]- ODGÕU .DQJUHORU KDOHQ WLFDUL NXOODQÕPD VXQXOPDPÕú
ROPDPDNOD ELUOLNWH JHOHFHNWH DQWLDJUHJDQ LODo DODQ
KDVWDODUGDSHULRSHUDWLIG|QHPGHN|SUOHPHDPDFÕ\OD
NXOODQÕODELOHFHNELUDMDQRODUDN|QHoÕNPDNWDGÕU
<HQLRUDODQWLNRDJODQLODoODU×NXOODQDQ
KDVWDODUGD\DNODü×P
6RQ \ÕOODUGD SXOPRQHU HPEROLOL YH DWUL\XP ¿EUL- ODV\RQOX KDVWDODUGD WURPERHPEROL WHGDYLVLQGH GD- ELJDWUDQ ULYDURNVDEDQ YH DSLNVDEDQ JLEL \HQL RUDO
DQWLNRDJODQ DMDQODUÕQ YLWDPLQ . DQWDJRQLVWL \HULQH
NXOODQÕPÕJQGHPGHGLU%XDMDQODUGDQGDELJDWUDQYH
ULYDURNVDEDQ SXOPRQHU HPEROL WHGDYLVLQGH GDELJDW- UDQ LVH DWUL\XP ¿EULODV\RQOX KDVWDODUÕQ WHGDYLVLQGH
)'$)RRGDQG'UXJ$GPLQLVWUDWLRQRQD\ÕDOPÕúWÕU
%X\HQLLODoODUÕQIDUPDNRORMLN|]HOOLNOHULQLQSHULRSH- UDWLIG|QHPGHKHSDULQLOHN|SUOHPHJHUH÷LQLRUWDGDQ
NDOGÕUDELOHFH÷L GúQOPHNWHGLU 9LWDPLQ . DQWDJR- QLVWLRODQYDUIDULQGHQIDUNOÕRODUDNEX\HQLLODoODUÕQ
|QJ|UOHELOLUYHVDELWDQWLNRDJODQHWNLOHULYDUGÕUYH
ODERUDWXYDU L]OHPL JHUHNWLUPH]OHU 2UDO DOÕP VRQUDVÕ
GRUXN SOD]PD NRQVDQWUDV\RQODUÕQD GDELJDWUDQ
VDDWYHULYDURNVDEDQVDDWLoLQGHXODúÕUODUYH
HWNLQOLNOHULEDúODU'DELJDWUDQÕQ\DUÕ|PUVDDW
ULYDURNVDEDQÕQVDDWWLU
>@%XLODoODUÕQHWNLOHUL- QLQKÕ]OÕYH\DUÕODQPD|PUOHULQLQNÕVDROPDVÕSHUL- RSHUDWLI G|QHPGH KHSDULQOH N|SUOHQPH \DSPDGDQ
NXOODQÕOPDODUÕQDRODQDNVD÷OD\DELOHFHNWLU$QFDNVRQ
ELUNDo \ÕOGD NXOODQÕPD JLUHQ EX \HQL YH JoO DQWL- NRDJODQODUÕQ DQWLGRWODUÕQÕQ EXOXQPDGÕ÷Õ GD XQXWXO- PDPDOÕGÕU %XQD HN RODUDN E|EUHN \HWHUVL]OL÷L RODQ
KDVWDODUGDGDELJDWUDQÕQ\DUÕ|PUEHOLUJLQRODUDNDUW- PDNWDGÕU.UHDWLQLQNOLUHQVLPOGNRODQKDVWDODU- GDVWDQGDUWX\JXODPDFHUUDKLJLULúLPGHQVDDW|QFH
GDELJDWUDQÕQNHVLOPHVLLNHQPDM|UFHUUDKL\DSÕODFDN
\DGD\NVHNNDQDPDULVNLRODQKDVWDODUGDEXVUH
JQ RODUDN ELOGLULOPHNWHGLU 'DELJDWUDQÕQ NUHDWLQLQ
NOLUHQVL POGN RODQ KDVWDODUGD FHUUDKLGHQ
JQ|QFHPDM|UFHUUDKL\DSÕODFDNYH\D\NVHNND- QDPDULVNLRODQKDVWDODUGDJQ|QFHNUHDWLQNOL- UHQVLPOGNRODQKDVWDODUGDJQ|QFHPDM|U
FHUUDKL\DSÕODFDNYH\D\NVHNNDQDPDULVNLRODQKDV-
WDODUGDJQ|QFHNHVLOPHVL|QHULOPHNWHGLU
<HQLRUDODQWLNRDJODQYHDQWLDJUHJDQLODoODU×NXOODQDQKDVWDODUGDSHULRSHUDWLI\DNODü×P
*HQHOOLNOH KDVWDODUÕQ SHULRSHUDWLI NDQDPD ULVNL- QH ED÷OÕ RODUDN EX LODoODUÕQ FHUUDKL JLULúLPGHQ
VDDW |QFH NHVLOPHVL YH KHPRVWD] VD÷ODQGÕNWDQ VRQUD
'0$+LOHN|SUOHPHJHUH÷LROPDGDQGúNNDQDPD
ULVNL RODQ KDVWDODUGD \NVHN NDQDPD ULVNL RODQ
KDVWDODUGD LVH VDDW LoLQGH WHNUDU EDúODQPDVÕ
|QHULOPHNWHGLU$QFDNED]ÕKDVWDODUGDFHUUDKLJLULúLP
VRQUDVÕG|QHPGHRUDO\ROODLODoNXOODQÕODPD\DELOHFH-
÷LQGHQ EX KDVWDODUGD \LQH GH '0$+¶\H JHUHNVLQLP
GX\XODELOHFH÷LXQXWXOPDPDOÕGÕU
<D]DUODU\DGD\D]ÕLOHLOJLOLELOGLULOHQKHUKDQJLELU
LOJLoDNÕúPDVÕFRQÀLFWRILQWHUHVW\RNWXU
.$<1$./$5
1. Kozek-Langenecker SA. New anticoagulants: perioperative considerations. Wien Med Wochenschr 2011;161:63-7.
2. Rosencher N, Bonnet MP, Sessler DI. Selected new antithrom- botic agents and neuraxial anaesthesia for major orthopaedic surgery: management strategies. Anaesthesia 2007;62:1154- 60.
3. Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, et al. Guidelines for pre-operative cardiac risk as- sessment and perioperative cardiac management in non-car- diac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non- cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 2010;27:92-137.
4. Brilakis ES, Banerjee S, Berger PB. Perioperative manage- ment of patients with coronary stents. J Am Coll Cardiol 2007;49:2145-50.
5. Akowuah E, Shrivastava V, Jamnadas B, Hopkinson D, Sarkar P, Storey R, et al. Comparison of two strategies for the management of antiplatelet therapy during urgent surgery.
Ann Thorac Surg 2005;80:149-52.
6. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation 2009;120:2577-85.
7. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho
KK, et al. A clinical trial comparing three antithrombotic- drug regimens after coronary-artery stenting. Stent Anti- coagulation Restenosis Study Investigators. N Engl J Med 1998;339:1665-71.
8. Mascelli MA, Kleiman NS, Marciniak SJ Jr, Damaraju L, Weisman HF, Jordan RE. Therapeutic heparin concentrations augment platelet reactivity: implications for the pharmaco- logic assessment of the glycoprotein IIb/IIIa antagonist abcix- imab. Am Heart J 2000;139:696-703.
9. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coro- nary syndromes in patients presenting without persistent ST- segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting with- out persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999-3054.
10. Held C, Asenblad N, Bassand JP, Becker RC, Cannon CP, Claeys MJ, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the PLATO (Platelet Inhibition and Patient Outcomes) trial. J Am Coll Cardiol 2011;57:672- 84.
11. Angiolillo DJ, Firstenberg MS, Price MJ, Tummala PE, Hutyra M, Welsby IJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a random- ized controlled trial. JAMA 2012;307:265-74.
12. Stangier J, Rathgen K, Stähle H, Gansser D, Roth W. The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 2007;64:292-303.
13. Mismetti P, Laporte S. Rivaroxaban: clinical pharmacology.
[Article in French] Ann Fr Anesth Reanim 2008;27:16-21.
[Abstract]
$QDKWDU V|]FNOHU $QWLNRDJODQ\DQ HWNL DSLNVDEDQ GDELJDWUDQ
LODoX\JXODPDWDNYLPLLODoHWNLOHüLPOHULNDQDPDNDQSHULRSHUDWLI
EDN×PSUDVXJUHOULVNIDNW|UOHULULYDURNVDEDQWLNDJUHORU\|QHWLP
Dù×]GDQ
.H\ZRUGV $QWLFRDJXODQWVDGYHUVHHIIHFWVDSL[DEDQGDELJDWUDQ
GUXJDGPLQLVWUDWLRQVFKHGXOHGUXJLQWHUDFWLRQVKHPRUUKDJHEORRG
SHULRSHUDWLYHFDUHSUDVXJUHOULVNIDFWRUVULYDUR[DEDQWLFDJUHORU
DGPLQLVWUDWLRQRUDO