Verification and medical economic evaluation of selective and individual for prevention pulmonary thromboembolism in cesarean section
| Project/Area Number |
19K10488
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 58010:Medical management and medical sociology-related
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| Research Institution | Nara Medical University |
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Principal Investigator |
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| Co-Investigator(Kenkyū-buntansha) |
常見 泰平 奈良県立医科大学, 医学部附属病院, 研究員 (20599831)
佐道 俊幸 奈良県立医科大学, 医学部, 研究員 (50275335)
竹田 善紀 奈良県立医科大学, 医学部附属病院, 研究員 (50825239)
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| Project Period (FY) |
2019-04-01 – 2022-03-31
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| Project Status |
Completed (Fiscal Year 2021)
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| Budget Amount *help |
¥3,770,000 (Direct Cost: ¥2,900,000、Indirect Cost: ¥870,000)
Fiscal Year 2021: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2020: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2019: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
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| Keywords | 静脈血栓塞栓症 / 抗凝固薬 / 帝王切開術 / 予防法 / 肺血栓塞栓症 / 深部静脈血栓症 / 血栓予防 / 医療経済的評価 |
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| Outline of Research at the Start |
帝王切開術後において「リスク因子」に応じた適切な抗凝固薬による薬物的予防を行えば、一般診療所においても抗凝固薬を中心とした周術期VTE予防ができる可能と考え、選択的・個別的なVTE予防プログラム（PROVEN study 4）を立案した。一方、抗凝固薬の重篤な出血という有害事象を避けるためには「除外基準」や「減量・中止基準」も必要になる。すなわち帝王切開術後のVTEによる産婦死亡をゼロにするためには、「リスク因子」と「除外基準」、「減量・中止基準」による適切な抗凝固薬使用の適応基準を定め、簡便なおかつ安全・有効で副作用の少ないVTE予防法を広く普及させることが重要であると考える。
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| Outline of Final Research Achievements |
The purpose of this study was to implement and validate a simple, safe, effective and less adverse event of anticoagulant VTE prophylaxis in cesarean section. A single-center prospective study was conducted among pregnant women who were performed cesarean section. Patients with VTE risk factor were initially received unfractionated heparin, starting 6 hours after cesarean section, and then received enoxaparin for 5 days. Patients did not receive anticoagulants if one or more of exclusion criteria were met. There were 897 cases of cesarean section during the study period. No symptomatic venous thromboembolism was observed after cesarean section in this protocol. Minor bleeding was observed in 34 patients who received anticoagulant, but only one major bleeding was observed. This protocol, which clarified the criteria for anticoagulants administration and dose reduction/discontinuation, was considered effective in preventing the development of VTE after cesarean section.
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| Academic Significance and Societal Importance of the Research Achievements |
帝王切開術後において、「リスク因子」に応じた適切な抗凝固薬による予防を行えば、一般診療所においても抗凝固薬を中心とした周術期VTE予防ができる可能と考え、選択的・個別的なVTE予防プログラムを立案した。
本研究の結果より術後の肺塞栓症発症は認めず、また抗凝固薬の有害事象であるminor bleedingは34例に認めたが、major bleedingは1例のみであった。すなわち「リスク因子」と「除外基準」、「減量・中止基準」による適切な抗凝固薬使用の適応基準を定め、煩雑なVTEスクリーニングを必要としない、簡便なおかつ安全・有効で副作用の少ないVTE予防法を普及させることが証明できたと考える。
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Report
(4 results)
Research Products
(29 results)
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[Journal Article] Guideline for Gynecological Practice in Japan: Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists 2020 edition2021
Author(s)
Kawaguchi R, Matsumoto K, Ishikawa T, Ishitani K, Okagaki R, Ogawa M, Oki T, Ozawa N, Kawasaki K, Kuwabara Y, Koga K, Sato Y, Takai Y, Tanaka K, Tanebe K, Terauchi M, Todo Y, Nose-Ogura S, Noda T, Baba T, Fujii E, Fujii T, Miyazaki H, Yoshino O, Yoshimura K, Maeda T, Kudo Y, Kobayashi H.
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Journal Title
The Journal of Obstetrics and Gynecology Research
Volume: 47
Issue: 1
Pages: 5-25
DOI
Related Report
Peer Reviewed
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[Journal Article] TRAF7 mutations and immunohistochemical study of uterine adenomatoid tumor compared with malignant mesothelioma2021
Author(s)
Itami H, Fujii T, Nakai T, Takeda M, Kishi Y, Taniguchi F, Terada C, Okada F, Nitta Y, Matsuoka M, Sasaki S, Sugimoto S, Uchiyama T, Morita K, Kasai T, Kawaguchi R, Ohbayashi C.
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Journal Title
Human Pathology
Volume: 111
Pages: 59-66
DOI
Related Report
Peer Reviewed
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[Journal Article] Phase 1/2 study of concurrent chemoradiotherapy with weekly irinotecan hydrochloride for advanced/recurrence uterine cancer: A multi-institutional study of Kansai Clinical Oncology Group2020
Author(s)
Takeuchi S, Kuroboshi H, Mori T, Ito K, Kondo E, Tabata T, Itani Y, Kawaguchi R, Takeuchi K, Soejima T, Sasaki R.
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Journal Title
Chinese Journal of Cancer Research
Volume: 32
Issue: 2
Pages: 218-227
DOI
Related Report
Peer Reviewed
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