Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Institute for Multimedia and Interactive Systems, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Langenbecks Arch Surg. 2019 Aug;404(5):633-645. doi: 10.1007/s00423-019-01796-9. Epub 2019 Jun 17.
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.
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.
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).
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.
口服抗凝药物（OAC）的围手术期管理是介入和手术治疗中的一个持续挑战。在决定停止 OAC 治疗时，必须权衡血栓栓塞事件的风险与计划手术期间和之后出血的风险。这些风险因患者而异，必须个别考虑。
POPACTApp 是一种用于口服抗凝药物围手术期或围介入期管理的应用程序，它是使用以人为中心的设计过程（ISO 9241-210:2010）开发的。这里开发的治疗概念可以根据患者的个体风险概况进行调整。POPACTApp 基于指南、共识声明和研究数据提供建议。输入患者特定的风险因素后，使用 POPACTApp 的主治医生会收到一个清晰、直接的围手术期治疗方案，这应该能够使其在日常临床实践中高效使用该程序。围手术期治疗方案通过时间线呈现，包括 (1) 是否中断 OAC 的决策，(2) 中断情况下最后一次术前 OAC 给药的时间，(3) 是否以及如何用肝素桥接的决策，和 (4) 何时重新开始抗凝的决策。
一项针对 20 名外科医生进行的基于任务的调查，以评估 POPACTApp 的可用性，结果表明所有医生都正确地解释了该应用程序提供的建议。此外，一项使用 7 点李克特量表（-3 表示负面，+3 表示正面）的问卷调查显示，针对三个具体问题的结果如下：(1) 对参与者所在单位当前标准程序的满意度（0.15；SD=1.57），(2) 对 POPACTApp 应用程序的个人满意度（2.7；SD=0.47），和 (3) 对 POPACTApp 在临床实践中有用性的估计（2.7；SD=0.47）。
POPACTApp 根据当前指南、共识声明和研究数据为 OAC 的围手术期或围介入期管理提供个体化风险优化的治疗方案，能够在日常临床实践中标准化地处理 OAC 的围手术期管理。
