Michael Thomaschewski1, Florens Beyer2, Martin Thomaschewski3, David Ellebrecht4, Markus Jonczyk5, Matthias Schneider5, Tobias Keck4, Tilo Mentler2, Richard Hummel4. 1. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. Michael.Thomaschewski@uksh.de. 2. Institute for Multimedia and Interactive Systems, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. 3. Center for Nano Optics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark. 4. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. 5. Department of Vascular Surgery, Academic Teaching Hospital St. Adolf-Stift, University of Hamburg, Hamburger Straße 41, 21465, Reinbek, Germany.
Abstract
PURPOSE: Perioperative management of oral anticoagulation (OAC) is a constant challenge in interventional and surgical procedures. When deciding to discontinue OAC, the risk of thromboembolic events must be balanced against the risk of bleeding during and after the planned procedure. These risks differ across patients and must be considered individually. METHODS: POPACTApp, an application for the perioperative or peri-interventional management of oral anticoagulants, was developed using a human-centered design process (ISO 9241-210:2010). The treatment concept developed here can be adapted to a patient's individual risk profile. POPACTApp provides recommendations based on guidelines, consensus statements, and study data. After entering patient-specific risk factors, the attending physician using POPACTApp receives a clear and direct presentation of a periprocedural treatment concept, which should enable the efficient use of the program in everyday clinical practice. The perioperative treatment concept is presented via a timeline, including (1) the decision on whether to interrupt OAC, (2) the timing of the last preoperative administration of OAC in cases of interruption, (3) the decision on whether and how to bridge with heparins, and (4) the decision about when to reinitiate anticoagulation. RESULTS: A task-based survey to evaluate POPACTApp's usability conducted with 20 surgeons showed that all clinicians correctly interpreted the recommendations provided by the app. Further, a questionnaire using a 7-point Likert scale from - 3 (negative) to + 3 (positive) revealed the following results to three specific questions: (1) satisfaction with the current standard procedure in the respective unit of the participant (0.15; SD = 1.57), (2) individual satisfaction with the POPACTApp application (2.7; SD = 0.47), and (3) estimation of the usefulness of POPACTApp for clinical practice (2.7; SD = 0.47). CONCLUSIONS: POPACTApp provides clinicians with an individual risk-optimized treatment concept for the perioperative or peri-interventional management of OAC based on current guidelines, consensus statements, and study data, enabling the standardized perioperative handling of OAC in daily clinical practice.
PURPOSE: Perioperative management of oral anticoagulation (OAC) is a constant challenge in interventional and surgical procedures. When deciding to discontinue OAC, the risk of thromboembolic events must be balanced against the risk of bleeding during and after the planned procedure. These risks differ across patients and must be considered individually. METHODS: POPACTApp, an application for the perioperative or peri-interventional management of oral anticoagulants, was developed using a human-centered design process (ISO 9241-210:2010). The treatment concept developed here can be adapted to a patient's individual risk profile. POPACTApp provides recommendations based on guidelines, consensus statements, and study data. After entering patient-specific risk factors, the attending physician using POPACTApp receives a clear and direct presentation of a periprocedural treatment concept, which should enable the efficient use of the program in everyday clinical practice. The perioperative treatment concept is presented via a timeline, including (1) the decision on whether to interrupt OAC, (2) the timing of the last preoperative administration of OAC in cases of interruption, (3) the decision on whether and how to bridge with heparins, and (4) the decision about when to reinitiate anticoagulation. RESULTS: A task-based survey to evaluate POPACTApp's usability conducted with 20 surgeons showed that all clinicians correctly interpreted the recommendations provided by the app. Further, a questionnaire using a 7-point Likert scale from - 3 (negative) to + 3 (positive) revealed the following results to three specific questions: (1) satisfaction with the current standard procedure in the respective unit of the participant (0.15; SD = 1.57), (2) individual satisfaction with the POPACTApp application (2.7; SD = 0.47), and (3) estimation of the usefulness of POPACTApp for clinical practice (2.7; SD = 0.47). CONCLUSIONS: POPACTApp provides clinicians with an individual risk-optimized treatment concept for the perioperative or peri-interventional management of OAC based on current guidelines, consensus statements, and study data, enabling the standardized perioperative handling of OAC in daily clinical practice.
Entities:
Keywords:
Medical application; Perioperative anticoagulant therapy; Perioperative bridging; Perioperative management of oral anticoagulation; Usability