Use of a web-based tool to aid periprocedural management of anticoagulation in a community hospital and in-network referral base

Purpose: To standardize and streamline periprocedural anticoagulation management in our community hospital and across referring practices within our network.

Methods/Materials: Management of patients on anticoagulation therapy undergoing intervention is complex and constantly evolving. The American Heart Association anticipates increased long-term anticoagulation use for treatment of thromboembolic disease and estimates around 10% of patients receiving long-term anticoagulation will require an invasive procedure in a given year. For minimally-invasive procedures performed by interventional radiologists, Society of Interventional Radiology (SIR) has published practice guidelines which aid in periprocedural management of anticoagulants. In community practices both interventional and diagnostic radiologists perform image-guided procedures, therefore periprocedural anticoagulation management is not standardized. As for breast interventions, Society of Breast Imaging does not offer specific recommendations. Lack of streamlined guidelines within a radiology department and across a network of referring providers results in cancelled procedures and confusion between patients and clinicians regarding anticoagulation management.

Results: In an effort to streamline and standardize periprocedural management of anticoagulation we created a web-based tool to query anticoagulant management guidelines (withholding and reinitiation of medications) for interventional procedures (i.e. vascular access, biopsies, abscess drainage, cholecystostomy, nephrostomy, gastrostomy), fluoroscopic-guided procedures (i.e. joint aspiration/injection, lumbar puncture) and breast procedures (i.e. fine-needle aspiration, core/stereotactic vacuum biopsy). SIR and the British Society of Breast Radiology anticoagulation guidelines were used. Iterations of our tool were made using Microsoft Excel’s PivotTable and AirTable’s Interfaces.

Conclusions: We aim to make our tool standard within our department and available to referring providers within our network. This will aid communication between the radiologist and the referring providers and reduce cancellations which will improve patient care delivered by radiologists in a community practice.