Skip to main content
Erschienen in: Langenbeck's Archives of Surgery 5/2019

17.06.2019 | Original Article

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

verfasst von: Michael Thomaschewski, Florens Beyer, Martin Thomaschewski, David Ellebrecht, Markus Jonczyk, Matthias Schneider, Tobias Keck, Tilo Mentler, Richard Hummel

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 5/2019

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
2.
6.
Zurück zum Zitat Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285(22):2864–2870CrossRefPubMed Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285(22):2864–2870CrossRefPubMed
9.
12.
Zurück zum Zitat January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64 (21):e1–76. https://doi.org/10.1016/j.jacc.2014.03.022 January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64 (21):e1–76. https://​doi.​org/​10.​1016/​j.​jacc.​2014.​03.​022
13.
Zurück zum Zitat Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL Jr, Ortel TL, Saxonhouse SJ, Spinler SA (2017) 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: A report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 69(7):871–898. https://doi.org/10.1016/j.jacc.2016.11.024 CrossRefPubMed Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL Jr, Ortel TL, Saxonhouse SJ, Spinler SA (2017) 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: A report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 69(7):871–898. https://​doi.​org/​10.​1016/​j.​jacc.​2016.​11.​024 CrossRefPubMed
16.
Zurück zum Zitat Ergonomics of human-system interaction—part 210: human-centred design for interactive systems (ISO 9241-210:2010) Ergonomics of human-system interaction—part 210: human-centred design for interactive systems (ISO 9241-210:2010)
20.
Zurück zum Zitat Di Biase L, Burkhardt JD, Santangeli P, Mohanty P, Sanchez JE, Horton R, Gallinghouse GJ, Themistoclakis S, Rossillo A, Lakkireddy D, Reddy M, Hao S, Hongo R, Beheiry S, Zagrodzky J, Rong B, Mohanty S, Elayi CS, Forleo G, Pelargonio G, Narducci ML, Dello Russo A, Casella M, Fassini G, Tondo C, Schweikert RA, Natale A (2014) Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation 129(25):2638–2644. https://doi.org/10.1161/CIRCULATIONAHA.113.006426 CrossRefPubMed Di Biase L, Burkhardt JD, Santangeli P, Mohanty P, Sanchez JE, Horton R, Gallinghouse GJ, Themistoclakis S, Rossillo A, Lakkireddy D, Reddy M, Hao S, Hongo R, Beheiry S, Zagrodzky J, Rong B, Mohanty S, Elayi CS, Forleo G, Pelargonio G, Narducci ML, Dello Russo A, Casella M, Fassini G, Tondo C, Schweikert RA, Natale A (2014) Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation 129(25):2638–2644. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​113.​006426 CrossRefPubMed
21.
Zurück zum Zitat Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, Ma CS, Hess S, Wells DS, Juang G, Vijgen J, Hugl BJ, Balasubramaniam R, De Chillou C, Davies DW, Fields LE, Natale A, Investigators V-A (2015) Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J 36(28):1805–1811. https://doi.org/10.1093/eurheartj/ehv177 CrossRefPubMedPubMedCentral Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, Ma CS, Hess S, Wells DS, Juang G, Vijgen J, Hugl BJ, Balasubramaniam R, De Chillou C, Davies DW, Fields LE, Natale A, Investigators V-A (2015) Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J 36(28):1805–1811. https://​doi.​org/​10.​1093/​eurheartj/​ehv177 CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Beyer-Westendorf J, Gelbricht V, Forster K, Ebertz F, Kohler C, Werth S, Kuhlisch E, Stange T, Thieme C, Daschkow K, Weiss N (2014) Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 35(28):1888–1896. https://doi.org/10.1093/eurheartj/eht557 CrossRefPubMed Beyer-Westendorf J, Gelbricht V, Forster K, Ebertz F, Kohler C, Werth S, Kuhlisch E, Stange T, Thieme C, Daschkow K, Weiss N (2014) Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 35(28):1888–1896. https://​doi.​org/​10.​1093/​eurheartj/​eht557 CrossRefPubMed
25.
Zurück zum Zitat Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P (2015) Updated European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 17(10):1467–1507. https://doi.org/10.1093/europace/euv309 CrossRefPubMed Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P (2015) Updated European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 17(10):1467–1507. https://​doi.​org/​10.​1093/​europace/​euv309 CrossRefPubMed
26.
Zurück zum Zitat Albaladejo P, Pernod G, Godier A, de Maistre E, Rosencher N, Mas JL, Fontana P, Samama CM, Steib A, Schlumberger S, Marret E, Roullet S, Susen S, Madi-Jebara S, Nguyen P, Schved JF, Bonhomme F, Sie P, members of the French Working Group on Perioperative H (2018) Management of bleeding and emergency invasive procedures in patients on dabigatran: updated guidelines from the French Working Group on Perioperative Haemostasis (GIHP)—September 2016. Anaesth Crit Care Pain Med 37(4):391–399. https://doi.org/10.1016/j.accpm.2018.04.009 CrossRefPubMed Albaladejo P, Pernod G, Godier A, de Maistre E, Rosencher N, Mas JL, Fontana P, Samama CM, Steib A, Schlumberger S, Marret E, Roullet S, Susen S, Madi-Jebara S, Nguyen P, Schved JF, Bonhomme F, Sie P, members of the French Working Group on Perioperative H (2018) Management of bleeding and emergency invasive procedures in patients on dabigatran: updated guidelines from the French Working Group on Perioperative Haemostasis (GIHP)—September 2016. Anaesth Crit Care Pain Med 37(4):391–399. https://​doi.​org/​10.​1016/​j.​accpm.​2018.​04.​009 CrossRefPubMed
31.
Zurück zum Zitat Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL; ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease Eur J Cardiothorac Surg 1;52(4):616–664. https://doi.org/10.1093/ejcts/ezx324 Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL; ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease Eur J Cardiothorac Surg 1;52(4):616–664. https://​doi.​org/​10.​1093/​ejcts/​ezx324
33.
Zurück zum Zitat van der Pligt P, Ball K, Hesketh KD, Teychenne M, Crawford D, Morgan PJ, Collins CE, Campbell KJ (2017) A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study. J Hum Nutr Diet 31:314–328. https://doi.org/10.1111/jhn.12521 CrossRefPubMed van der Pligt P, Ball K, Hesketh KD, Teychenne M, Crawford D, Morgan PJ, Collins CE, Campbell KJ (2017) A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study. J Hum Nutr Diet 31:314–328. https://​doi.​org/​10.​1111/​jhn.​12521 CrossRefPubMed
35.
Zurück zum Zitat Pais S, Parry D, Petrova K, Rowan J (2017) Acceptance of using an ecosystem of mobile apps for use in diabetes clinic for self-management of gestational diabetes mellitus. Stud Health Technol Inform 245:188–192PubMed Pais S, Parry D, Petrova K, Rowan J (2017) Acceptance of using an ecosystem of mobile apps for use in diabetes clinic for self-management of gestational diabetes mellitus. Stud Health Technol Inform 245:188–192PubMed
41.
Zurück zum Zitat Curcio A, DER S, Sabatino J, DEL S, Bochicchio A, Polimeni A, Santarpia G, Ricci P, Indolfi C (2016) Clinical usefulness of a mobile application for the appropriate selection of the antiarrhythmic device in heart failure. Pacing Clin Electrophysiol 39(7):696–702. https://doi.org/10.1111/pace.12872 CrossRefPubMed Curcio A, DER S, Sabatino J, DEL S, Bochicchio A, Polimeni A, Santarpia G, Ricci P, Indolfi C (2016) Clinical usefulness of a mobile application for the appropriate selection of the antiarrhythmic device in heart failure. Pacing Clin Electrophysiol 39(7):696–702. https://​doi.​org/​10.​1111/​pace.​12872 CrossRefPubMed
42.
Zurück zum Zitat Douketis JD, Healey JS, Brueckmann M, Eikelboom JW, Ezekowitz MD, Fraessdorf M, Noack H, Oldgren J, Reilly P, Spyropoulos AC, Wallentin L, Connolly SJ (2015) Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure. Substudy of the RE-LY trial. Thromb Haemost 113(3):625–632. https://doi.org/10.1160/TH14-04-0305 CrossRefPubMed Douketis JD, Healey JS, Brueckmann M, Eikelboom JW, Ezekowitz MD, Fraessdorf M, Noack H, Oldgren J, Reilly P, Spyropoulos AC, Wallentin L, Connolly SJ (2015) Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure. Substudy of the RE-LY trial. Thromb Haemost 113(3):625–632. https://​doi.​org/​10.​1160/​TH14-04-0305 CrossRefPubMed
Metadaten
Titel
Application-based management of perioperative anticoagulant therapy: description of POPACTApp
verfasst von
Michael Thomaschewski
Florens Beyer
Martin Thomaschewski
David Ellebrecht
Markus Jonczyk
Matthias Schneider
Tobias Keck
Tilo Mentler
Richard Hummel
Publikationsdatum
17.06.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 5/2019
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-019-01796-9

Weitere Artikel der Ausgabe 5/2019

Langenbeck's Archives of Surgery 5/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.