{"created":"2021-03-01T06:30:53.871459+00:00","id":25430,"links":{},"metadata":{"_buckets":{"deposit":"55471a60-b14c-451e-b79e-3911ab41981e"},"_deposit":{"id":"25430","owners":[],"pid":{"revision_id":0,"type":"depid","value":"25430"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:00025430","sets":["432:1291:1292:1297","453:456"]},"item_7_alternative_title_1":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Peri-operative management at oral surgery for patients undergoing antithrombotic therapy : Validation of the systemic management in our department"}]},"item_7_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2010-12","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"158","bibliographicPageStart":"149","bibliographicVolumeNumber":"40","bibliographic_titles":[{"bibliographic_title":"新潟歯学会雑誌"},{"bibliographic_title":"新潟歯学会雑誌","bibliographic_titleLang":"en"}]}]},"item_7_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"昨今，抗血栓療法患者における歯科観血処置前の慣習的な休薬が見直されるようになり，当科でも2006年１月以降，原則非休薬の治療方針をマニュアル化して診療にあたっている。今回，当科のマニュアルの妥当性を検証し，術後出血リスクを効果的に軽減させる具体的方策を探ることを目的として，回顧的検討を行った。また，休薬せざるを得なかった症例についても，その周術期管理を考察した。対象は，2006年１月～2007年12月までに口腔外科処置を行った抗血栓療法患者で，非休薬下で施術した症例103名（のべ137回），休薬下で施術した症例９名（のべ９回），合計112名（のべ146回）である。術後出血の程度と時期，血栓塞栓性合併症の有無と時期を評価するとともに，各種止血処置と術後出血の関連を検討した。その結果，非休薬群では137例中22例（16.1％）に術後出血を認め，出血時期は全て術直後であった。特徴的な結果として，抗凝固療法患者に術後出血が有意に多かったが，PT-INRと出血頻度に相関はなかった。また，術野が広範囲になるに従い術後出血が増加し，抜歯症例に限ると，抜歯数の増加にともない術後出血も増加した。止血処置に関して，止血材料使用と縫合を単独もしくは併用した症例で術後出血が減少した。術後出血した症例は，いずれも直視直達による通常の後出血処置により止血可能で再出血はなかった。休薬群では９例中２例（22.2％）に術後出血があり，抗血栓療法再開時期を調整して出血管理を行い再出血はなかった。休薬群，非休薬群のいずれでも周術期に血栓塞栓症の徴候はなかった。当科の「抗血栓療法患者周術期管理マニュアル」に従い，全身的な要件として「病状照会（抗凝固療法患者ではPT-INR の把握）にて抗血栓療法を行うに至った基礎疾患を含む既往疾患が良好にコントロールされていること」，および局所的な要件として「予期せぬ術野からの出血に対し直視直達にて容易に止血可能と判断されること」が遵守され，「抗血栓療法の詳細，術野の状態，症例に応じた止血処置を勘案した周術期管理体制が整備」がなされていれば，安心で安全な口腔外科処置が抗血栓療法患者においても可能と考えられた。","subitem_description_type":"Abstract"},{"subitem_description":"Many recent reports have shown that oral surgery can be successfully performed for patients undergoing antithrombotic therapy. Since January 2006, we have treated these patients without drug cessation according to our peri-operative manual. In this study, we retrospectively evaluate postoperative bleeding in patients who received antithrombotic therapy in order to select effective procedure to reduce hemorrhagic risk. We also discuss how patient do not need to interrupt antithrombotic therapy for oral surgery. Finally we validated our peri-operative manual for these patients. We assessed 146 antithrombotic therapy cases, which included 137 cases without drug cessation and 9 cases with drug cessation, which had oral surgery between January 2006 and December 2007. A total of 22 of 137 cases (16.6%) without drug cessation required management of postoperative bleeding immediately after surgery. These cases, with significant amount of bleeding characteristic of Warfarin therapy, did not correlate with PT-INR and postoperative bleeding rate. For tooth extraction cases only, an increased number of tooth extraction increased postoperative bleeding. A haemostatic material, suture, or their combination of both diminished postoperative bleeding. There was no recurrence of postoperative bleeding when making full use of routine hemorrhagic control and without blood transfusion. For 2 of 9 cases (22.2%) with drug cessation, we managed postoperative bleeding. We successfully performed using routine hemorrhagic control along with adjustment of the timing for re-starting antithrombotic therapy. In conclusion, to retain our peri-operative manual for oral surgery for patients receiving antithrombotic therapy, there are two factors that may influence security and safety peri-operative management. One is identification of relevant control measures for a previous illness and antithrombotic therapy (including the latest PT-INR) with a medical referral from MD for permission for systemic use. Another factor is a judgment for the possibility of inconsequential postoperative bleeding using a direct procedure to easily obtain local hemorrhagic control. In addition, we should consider the kinds of antithrombotic therapy, wound conditions, mental management, and preparation of the peri-operative environment; these can be used to successfully manage oral surgery.","subitem_description_type":"Abstract"}]},"item_7_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"149931","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Yamada, Yushi"}]},{"nameIdentifiers":[{"nameIdentifier":"149932","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kodama, Yasumitsu"}]},{"nameIdentifiers":[{"nameIdentifier":"149933","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Nagata, Masaki"}]},{"nameIdentifiers":[{"nameIdentifier":"149934","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Hoshina, Hideyuki"}]},{"nameIdentifiers":[{"nameIdentifier":"149935","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Seo, Kenji"}]},{"nameIdentifiers":[{"nameIdentifier":"149936","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Takagi, Ritsuo"}]}]},"item_7_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟歯学会"}]},"item_7_select_19":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_select_item":"publisher"}]},"item_7_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN0018300X","subitem_source_identifier_type":"NCID"}]},"item_7_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"03850153","subitem_source_identifier_type":"ISSN"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"山田, 裕士"}],"nameIdentifiers":[{"nameIdentifier":"149925","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"児玉, 泰光"}],"nameIdentifiers":[{"nameIdentifier":"149926","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"永田, 昌毅"}],"nameIdentifiers":[{"nameIdentifier":"149927","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"星名, 秀行"}],"nameIdentifiers":[{"nameIdentifier":"149928","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"瀬尾, 憲司"}],"nameIdentifiers":[{"nameIdentifier":"149929","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"高木, 律男"}],"nameIdentifiers":[{"nameIdentifier":"149930","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-19"}],"displaytype":"detail","filename":"NS_40(2)_149-158.pdf","filesize":[{"value":"1.6 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"NS_40(2)_149-158.pdf","url":"https://niigata-u.repo.nii.ac.jp/record/25430/files/NS_40(2)_149-158.pdf"},"version_id":"96535976-bc1a-4cec-aa3e-9adbc9e5ed4a"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"抗血栓療法","subitem_subject_scheme":"Other"},{"subitem_subject":"周術期管理","subitem_subject_scheme":"Other"},{"subitem_subject":"口腔外科処置","subitem_subject_scheme":"Other"},{"subitem_subject":"周術期マニュアル","subitem_subject_scheme":"Other"},{"subitem_subject":"出血管理","subitem_subject_scheme":"Other"},{"subitem_subject":"antithrombotic therapy","subitem_subject_scheme":"Other"},{"subitem_subject":"peri-operative management","subitem_subject_scheme":"Other"},{"subitem_subject":"oral surgery","subitem_subject_scheme":"Other"},{"subitem_subject":"peri-operative manual","subitem_subject_scheme":"Other"},{"subitem_subject":"hemorrhagic control","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"抗血栓療法患者における口腔外科処置に関連した周術期管理の検討 : 当科における抗血栓療法患者周術期管理マニュアルの検証","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"抗血栓療法患者における口腔外科処置に関連した周術期管理の検討 : 当科における抗血栓療法患者周術期管理マニュアルの検証"},{"subitem_title":"抗血栓療法患者における口腔外科処置に関連した周術期管理の検討 : 当科における抗血栓療法患者周術期管理マニュアルの検証","subitem_title_language":"en"}]},"item_type_id":"7","owner":"1","path":["456","1297"],"pubdate":{"attribute_name":"公開日","attribute_value":"2017-07-19"},"publish_date":"2017-07-19","publish_status":"0","recid":"25430","relation_version_is_last":true,"title":["抗血栓療法患者における口腔外科処置に関連した周術期管理の検討 : 当科における抗血栓療法患者周術期管理マニュアルの検証"],"weko_creator_id":"1","weko_shared_id":null},"updated":"2022-12-15T03:55:21.739543+00:00"}