Background: Anticoagulants, like vitamin-K-antagonists (VKA) and direct oral anticoagulants (DOAC), are widely used, also among patients who undergo endoscopic procedures. To balance between bleeding and thrombotic risks careful decisions have to be made about whether and for how long anticoagulants have to be stopped peri-endoscopically and if bridging is necessary (VKA). In our hospital, we created a tool in the electronic health record (EHR) to aid this decision making.
Aims: Firstly, this study aims to assess whether the tool is used properly. Secondly, how many bleeding and thrombotic events have occurred since the implementation of the tool.
Methods: Orders placed for endoscopies by medical specialists between 2018 and 2021 were included. By filling in the bleeding and thrombotic risks, the tool automatically generates an advice for the peri-procedural anticoagulation. It was checked whether the decision-making tool was filled in correctly. Correct use was defined as following the national protocol as shown in pop-ups in the tool. Data about complications after endoscopies were collected retrospectively. A complication was defined as any thrombotic or bleeding event occurring within 30 days after endoscopy.
Results: In total 986 endoscopies were included for the analysis. The cumulative incidence for thrombotic or bleeding events was 2%. 14 bleeding events occurred, of which 1 needed intervention. There were 3 thrombotic events. In 89% the tool was used correctly; the main error was incorrect bleeding risk (8%).
Conclusion(s): This study evaluates the use of an EHR-integrated decision-making tool to aid proper anticoagulant use peri-endoscopically. By analyzing the incorrect usage of the tool, we formulated several suggestions to improve the tool. As this study is not a comparative one, it does not provide evidence on whether the tool is able to reduce complications. Future research will examine whether this tool leads to fewer peri-endoscopic complications.
Image
The tool integrated in the electronic health record which was created to guide proper decision-making regarding peri-endoscopic anticoagulant use
Table
Errors made by medical specialists when using the decision-making tool
To cite this abstract in AMA style:
Plender A, Faber L, Graumans S. A Tool Integrated in the Electronic Health Record to Guide Proper Decision-Making Regarding Peri-Endoscopic Anticoagulant Use [abstract]. https://abstracts.isth.org/abstract/a-tool-integrated-in-the-electronic-health-record-to-guide-proper-decision-making-regarding-peri-endoscopic-anticoagulant-use/. Accessed October 1, 2023.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-tool-integrated-in-the-electronic-health-record-to-guide-proper-decision-making-regarding-peri-endoscopic-anticoagulant-use/