By: Manoj M. Lalu, MD

“Is it safe for me to perform a regional or neuraxial procedure on this patient taking anticoagulants?”
This is a question we are often faced with in the operating room when dealing with patients taking anticoagulants. Answering this question has become increasingly difficult as both the number of anticoagulant drugs and the indications for these drugs have increased recently.

Fortunately, practice guidelines have been published by both the American Society for Regional Anesthesia and the European Society of Anaesthesiology. Unfortunately, the bulk of these documents makes it difficult to find the quick answers we often need.  This is where Coagulate, an app for both the iPhone/iPod Touch and the iPad, comes in.  This app was developed by LJ Cubed Apps and is a steal for 99 cents.

LJ Cubed has summarized the often expansive ASRA and ESA guidelines in a succinct manner.  Following the opening screen, a list of anticoagulant drugs covered by the guidelines appears.  I especially like the clean user interface of this screen. Drugs are listed alphabetically by either generic or trade name (whichever is used more commonly), and other names are listed underneath in smaller font.

Upon selecting a drug a secondary screen appears with details of that medication.  At the very top of this screen, quick links to “Reversal”, “ASRA”, and “ESA” can be found. Directly below this the authors have nicely summarized stop information (i.e. when to stop an anticoagulant prior to procedure) from both guidelines in a very basic and easily understood form. Where there is discrepancy between the ASRA and ESA guidelines, Coagulate tends to defer to the former.

For those wanting more detailed information, either the ASRA or ESA links can be pressed and text or tables from the guidelines appear.

Finally, for emergent procedures, guidelines for reversal are provided for many of the drugs listed.

On the iPad the app is essentially the same. In landscape mode, however, the user interface is slightly different with a permanent frame inserted for the list of drugs.


I bought this app when it first appeared in the iTunes store well over a year ago.  I have found it to be consistently useful in the OR setting. I often refer my ER and Internal Medicine colleagues to this app when questions about anticoagulants arise.  Perhaps most impressive has been its continuous updating by the developers.  When the ASRA guidelines were revised in 2010, LJ Cubed quickly updated their app to reflect these changes.  More recently, newer anticoagulants have been added. I hope these updates will continue to be done and keep this app relevant.


  • Succinct yet comprehensive
  • Clean user-interface


  • None given the price
  • Perhaps future updates could include useful pharmacological information (pharmacokinetic and dynamics) of the drugs while still keeping the clean interface


  • Most anesthesiologists will find this app far exceeds its 99 cent investment.

Dr. Lalu is a 4th year anesthesiology resident at the University of Ottawa.