Whether you are a cardiologist seeing new-onset atrial fibrillation, an orthopedic surgeon prescribing DVT prophylaxis after a hip replacement, an emergency room physician encountering a bleeding diathesis in the setting of a supratherapeutic INR, an intensivist treating a pulmonary embolus in the ICU, or a neurologist medically optimizing a stroke patient, it is critical to have a strong understanding of “blood thinners,” or various antiplatelet and anticoagulant agents. Here we review the Clot Rx App for the iPhone/iPad from Insight Therapeutics, an app that attempts to “provide the busy practitioner with quick access to information on the use of antithrombotic agents.”
Founded in 1996, Insight Therapeutics, LLC, is a Norfolk, Virginia-based “professional medical education, clinical research, and communications organization.” The ClotRx app represents Insight’s first and only app to date for the iPhone.
As many clinicians well know, pulmonary embolus is sudden and terrifying event. It can strike the healthy and the ill, even celebrity athletes. Therefore, an understanding of clot prevention is important. Read more to find out how well Clot Rx app does.
The app’s home screen features links to the Table of Contents, Card View, Disclaimers, and “About,” while the index bar at the bottom offers quick access to the home screen, the Table of Contents, Card View, and “About.” The Table of Contents offers browsing by medication or disease.
Browsing by medication offers three categories—antiplatelet medications (aspirin, aggrenox, plavix, and prasugrel), anticoagulant medications (pradaxa, arixtra, heparin, LMWH, and warfarin), and mechanism of action (antiplatelet or anticoagulant medications).
Clicking on a medication (here, plavix), offers links to dosing guidelines, adverse events, precautions/contraindications, and mechanism of action. As seen here, these medication pages, while straightforward and concise, do not offer much in the way of additional information compared to our ubiquitous drug references such as MedScape or MicroMedex.
Where this app does offer additional education beyond our trusty drug references when browsing by medication is under the Mechanism of Action category for antiplatelet and anticoagulant medications. Here we see two schematics (one from a journal article) that visually demonstrate how each of the listed medications affect platelet or coagulation function:
Alternatively, browsing by disease from the Table of Contents offers us a look at atrial fibrillation (a-fib), coronary artery disease (CAD), stroke or transient ischemic attack (TIA), peripheral arterial disease (PAD), and venous thromboembolism (deep venous thrombosis or pulmonary embolism (DVT or PE)).
Here, we will look into CAD, which has its information divided into categories of risk factors, stable angina, acute coronary syndromes (ACS), and an overview of vascular disease.
Clicking on stable angina displays a table with evidence-based (and cited) recommendations based on the ACCP and ACC/AHA guidelines covering the secondary prevention of CAD.
Similarly, exploring the ACS section displays its information in a similar easy-to-read table format with appropriate referencing as well as the strength of evidence supporting any recommendation.
Of note, the VTE category does offer sections covering the prevention (and not just the treatment) of DVT—an important topic for many inpatients.
Finally, the Card View provides 8 “cards” with densely-packed but useful information related to antithrombotic therapy. These cards would be excellent as pocket cards to print and stick inside one’s white coat (or easily access on one’s iPhone!). For example, topics covered include an overview of VTE, DVT and PE prophylaxis and anticoagulant reversal, treatment of VTE, stroke prevention, a warfarin overview, and warfarin drug interactions.
The ClotRX app costs $1.99 on iTunes.
- No matter what field of medicine or what level of training, antithrombotic therapy represents a common and frequent issue in clinical practice
- Information is displayed in easy-to-read table format or illustrations
- Evidence-based recommendations with cited references as well as strength of supporting evidence
- Simple and straightforward navigation within app
Dislikes/Future Updates I’d Love to See:
- Browsing by medication does not offer any advantage over drug references such as MedScape or MicroMedex
- Narrow scope of information limited to antithrombotic therapy—once this content is mastered, there’s minimal utility to be found here
This app does meet its stated goal of providing quick information on antithrombotic therapy. At my level (PGY-1), I found that I actually pulled out this app multiple times in a single day on my current rotation—inpatient general medicine at the Saint Louis VA Medical Center—to dose a heparin drip, double-check my decision to start a patient on warfarin for his new-onset atrial fibrillation, ensure I was giving a new admit the correct DVT prophylaxis, and make sure a stroke patient I inherited was on the correct regimen (and, perhaps most importantly, to learn about the strength of the evidence supporting each of these clinical decisions I was making). My use of this app will fade quickly, as I have quickly mastered most of the information in it, and the medication reference is no better (and much more limited) than the drug references most of us use regularly.
In summary, ClotRx offers a well-organized and evidence-based tutorial on the use of antithrombotic therapy that every medical student or intern would be well-served to master, especially given the importance of blood thinners in clinical practice. However, once the app’s content is grasped, it does not offer much value.