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Application-based management of perioperative anticoagulant therapy: description of POPACTApp

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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.

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Abbreviations

OAC :

Oral anticoagulation

App :

Application

AF :

Atrial fibrillation

DOAC :

Direct-acting anticoagulant

INR :

International normalized ratio

LMWH :

Low molecular weight heparins

POPACTApp :

Application for perioperative anticoagulant therapy

MHV :

Mechanical heart valve

Mobile app :

Application for mobile devices

SD :

Standard deviation

VTE :

Venous thromboembolism

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Acknowledgments

We thank Jennifer Barrett, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Michael Thomaschewski, David Ellebrecht, Tobias Keck & Richard Hummel

  2. Institute for Multimedia and Interactive Systems, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Florens Beyer & Tilo Mentler

  3. Center for Nano Optics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark

    Martin Thomaschewski

  4. Department of Vascular Surgery, Academic Teaching Hospital St. Adolf-Stift, University of Hamburg, Hamburger Straße 41, 21465, Reinbek, Germany

    Markus Jonczyk & Matthias Schneider

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Contributions

Study conception and design: MT, MT, FB, TM, RH. Acquisition of data: FB. Analysis and interpretation of data: MT, FB, TM, RH. Drafting the manuscript: MT, RH. Critical revision of the manuscript: DE, MJ, MS, TK, TM.

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Correspondence to Michael Thomaschewski.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethik-Kommission Universität zu Lübeck, Aktenzeichen 19-105A) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Supplementary Table 1

Sample procedures for different procedural risk categories for bleeding. Note: interv.: intervention (PPTX 52 kb)

Supplementary Table 2

20 hypothetical patients with AF, VTE, MHV and OAC requiring surgery. Note: OAC: oral anticoagulant, CrCl: creatinine clearance (DOCX 24 kb)

Supplementary Table 3

Demographics of study participants (DOCX 18 kb)

Supplementary Figure 1

Items of the task-based survey (PPTX 230 kb)

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Thomaschewski, M., Beyer, F., Thomaschewski, M. et al. Application-based management of perioperative anticoagulant therapy: description of POPACTApp. Langenbecks Arch Surg 404, 633–645 (2019). https://doi.org/10.1007/s00423-019-01796-9

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