福岡市内の病院勤務医師・歯科医師を対象とする抜歯時の抗血栓療法に関するアンケート調査

The Questionnaire Survey to Clarify Correspondence of Medical Doctors and Dentists in Fukuoka City, Japan, for Warfarin Therapy at the Dental Extraction

　要旨　【目的】抗血栓療法中の抜歯に関する病院勤務の医師や歯科医師の対応を明らかにする目的でアンケート調査を行った。【方法】福岡市内の歯科あるいは口腔外科を標榜している17病院17診療科の責任歯科医師17名と82病院142診療科の責任医師142名を対象に，歯科医師と医師用の調査用紙を用いて，心原性脳塞栓症歴がありワルファリン療法中の非弁膜性心房細動患者におけるワルファリン療法継続下での抜歯処置を支持するか否かなどをアンケート調査によって調べた。【結果】歯科医師14名（82.4％）と医師66名（46.5％）から回答を得た。ワルファリン療法継続下で抜歯する歯科医師と医師はそれぞれ12名（85.7％）と32名（48.5％）であった。診療専門領域別検討では循環器疾患診療医師（9/25，36.0％）より脳卒中診療医師（11/14，78.6％）のほうが支持する割合が高かった（p＝0.0187）。ワルファリン療法中止時に発症した脳梗塞症例の経験は脳卒中診療医師のほうが循環器疾患診療医師より高かった（57.1％ vs. 20.0％，p＝0.0327）。【結論】福岡市病院勤務の歯科医師と医師のワルファリン療法継続下での抜歯受け入れ率はそれぞれ85.7％と48.5％であった。医師の受け入れ率は専門領域別に異なり，ワルファリン療法中断に伴う脳梗塞症例経験の有無が関連しているものと推察された。

　Purpose : The questionnaire survey was performed in order to clarify correspondence of medical doctors and dentists working at hospital service for warfarin therapy at the dental extraction. Methods : For 17 senior dentists in 17 hospitals and 142 senior physicians in 82 hospitals in Fukuoka City, we investigated using the questionnaire whether they supported dental extraction under warfarin therapy or not in patients having warfarin treatment with past history of cardioembolic stroke due to non-valvular atrial fibrillation （NVAF）. Specialty and experience of stroke after withdrawal of warfarin were also asked in medical doctors. Result : The reply was obtained from 14 dentists （82.4％） and 66 doctors （46.5％）. The number of dentists and doctors who pull out a tooth under warfarin treatment continuation were 12 persons （85.7％） and 32 persons （48.5％）, respectively. The rates in doctors whose specialty was stroke, cardiovascular disease, and others were 78.6％ （11/14）, 36.0％（9/25）, and 44.4％（12/27）, respectively. The rate in stroke specialists was significantly higher than that in cardiovascular disease specialists （p＝0.019）. The stroke specialists had experience of stroke after withdrawal of warfarin more frequently than the cardiovascular disease specialists （57.1％ vs. 20.0％, p＝0.033）. Conclusion : The rates of acceptance in tooth extraction under warfarin treatment continuation of the dentist were high in Fukuoka city, while that of the medical doctors were not. Rate of doctor's acceptance differed according to the specialties, and may be affected by experience of stroke after cessation of warfarin therapy.