치과에서 시행되고 있는 시술 전 항혈전제 관련 처치에 대한 실태 파악 = Identify the status of pretreatment on antithrombotic agents in practice at the dentist s office

국문 초록 (Abstract)

최근 노인 인구에서 심뇌혈관 질환 환자들이 증가하면서 항혈전제 치료를 받는 환자들이 늘고 있다. 치과시술 전 항혈전제 중단에 대한 가이드라인이 있지만 실제 임상에서는 가이드라인과 다르게 적용하고 있어, 관리 실태 및 출혈에 대한 인식정도를 파악하기 위해 본 연구를 진행하였다. 연구방법은 치과의사들이 가입된 최대규모의 싸이트를 통해 설문지를 수집하였으며 이 중 설문연구 가치가 있는 자료 총 1000장의 설문지를 확보하였다. 설문조사내용은 일반적인 사항을 묻는 문항과 항혈전제 사용 병력 기록, 항혈전제로 인한 합병증 경험여부, 사용중단 여부, 사용중단 이유, 사용 중단 기간 등을 묻는 인식도 조사항목으로 이루어졌다. 연구결과는 환자의 항혈전제 사용 여부를 기록하는 비율은 92%로 높았고, 항혈전제 사용시 나타나는 지연출혈을 경험한 빈도는 55.1%, 발치 전 항혈전제 복용을 중단시키는 빈도는 87.8%, 중단이유가 지연출혈이라고 응답한 빈도는 98.3%, 중단 기간은 3-5일이 64%로 제일 높았다. 다음과 같은 점을 논의하였다. 임상현장에서는 지연출혈 정도나 빈도가 더 높거나 한국인 치과의사들은 환자의 정서적 문제, 환자 의사와의 관계, 추가적으로 발생되는 사회경제적인 문제를 고려해서 가이드라인보다 더 엄격하게 지연출혈에 대해 대처하고 있다고 해석된다.

다국어 초록 (Multilingual Abstract)

The purpose of this study is to understand using of antithrombotic agents in clinical settings. The number of patients receiving antithrombotic therapy is increasing in the long term due to the increased prevalence of cardiovascular disease in the elderly. There is a guideline for discontinuation of antithrombotic treatment before dental treatment, but the present study shows that there is a difference from the actual clinical situation. We used an online survey methodology to involve 1000 participants. The questionnaires were asked about general items and Clinical experience such as history of antithrombotic history, experience of complications due to antithrombotics, discontinuation of use, reasons for discontinuing use. The result is as follows. The incidence of delayed bleeding was found to be 55.1%, and discontinuation of antithrombotic therapy before withdrawal was 87.8%. Among respondents 98.3% responded that they stopped antithrombotics because of delayed bleeding and 57.4% responded that they would stop for three to five days. Korean dentists maybe cope with delayed bleeding considering the emotional problem of the patient, the relationship with the patient s physician, and the additional socioeconomic problems.

목차 (Table of Contents)

• Ⅰ. 서론 Ⅱ. 연구방법 Ⅲ. 연구결과 Ⅳ. 결론 및 제언 참고문헌

참고문헌 (Reference)

1 박태환, "한국인에서 허혈성 뇌졸중에 대한 주요 위험인자들의 인구기여위험도" 대한뇌졸중학회 10 (10): 125-133, 2008

2 임정숙, "준고령자의 노후생활기대감에 영향을 미치는 요인" 한국노년학회 39 (39): 569-587, 2019

3 Wendy McNeely, "Triflusal" Springer Science and Business Media LLC 55 (55): 823-833, 1998

4 Dodson, T. B., "Strategies for managing anticoagulated patients requiring dental extractions : an exercise in evidence-based clinical practice" 50 (50): 44-50, 2002

5 Mitchell L. Shiffman, "Risk of bleeding after endoscopic biopsy or polypectomy in patients taking aspirin or other NSAIDs" Elsevier BV 40 (40): 458-462, 1994

6 Charlotte Mérie, "Risk of Stroke After Coronary Artery Bypass Grafting" Ovid Technologies (Wolters Kluwer Health) 43 (43): 38-43, 2012

7 Yoshinari Morimoto, "Risk Factors Affecting Postoperative Hemorrhage After Tooth Extraction in Patients Receiving Oral Antithrombotic Therapy" Elsevier BV 69 (69): 1550-1556, 2011

8 William H. Geerts, "Prevention of Venous Thromboembolism" Elsevier BV 133 (133): 381S-453S, 2008

9 James D. Douketis, "Perioperative Management of Antithrombotic Therapy" Elsevier BV 141 (141): e326S-e350S, 2012

10 Christian Bacci, "Management of dental extraction in patients undergoing anticoagulant treatment" Georg Thieme Verlag KG 104 (104): 972-975, 2017

11 Anne Godier, "Management of antiplatelet therapy in patients undergoing elective invasive procedures: Proposals from the French Working Group on perioperative hemostasis (GIHP) and the French Study Group on thrombosis and hemostasis (GFHT). In collaboration with the French Society for Anesthesia and Intensive Care (SFAR)" Elsevier BV 111 (111): 210-223, 2018

12 W. BURGER, "Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis" Wiley 257 (257): 399-414, 2005

13 A M Veitch, "Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures" BMJ 57 (57): 1322-1329, 2008

14 Ehud I. Assia, "Effect of aspirin intake on bleeding during cataract surgery" Ovid Technologies (Wolters Kluwer Health) 24 (24): 1243-1246, 1998

15 Wahl, M. J., "Dental surgery in anticoagulated patients" 158 (158): 1610-1616, 1998

16 D. Blinder, "Dental extractions in patients maintained on oral anticoagulant therapy: Comparison of INR value with occurrence of postoperative bleeding" Elsevier BV 30 (30): 518-521, 2001

17 Lisa T. Newsome, "Coronary Artery Stents: II. Perioperative Considerations and Management" Ovid Technologies (Wolters Kluwer Health) 107 (107): 570-590, 2008

18 Pérez-Gómez, F., "Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation A randomized multicenter study" 44 (44): 1557-1566, 2004

19 Baglin, T. P., "British Committee for Standards in Haematology. guidelines on oral anticoagulation(warfarin) : third edition-2005 update" 132 (132): 277-285, 2006

20 Felix J.F. Herth, "Aspirin Does Not Increase Bleeding Complications After Transbronchial Biopsy" Elsevier BV 122 (122): 1461-1464, 2002

21 James W. Little, "Antithrombotic agents: Implications in dentistry" Elsevier BV 93 (93): 544-551, 2002