Clinical Scenario:

A 70 year-old female with a past medical history of hypertension, Type II diabetes, and chronic renal insufficiency was diagnosed with atrial fibrillation while undergoing a routine diabetes visit. The patient is completely asymptomatic and was unaware of how long she had been in afib, but states she was told she had this a few times over the last few years and was started on aspirin. Should this patient be on warfarin or a TSOAC? How would you adjust her warfarin if you started it?

The MAQI2 Anticoagulation Toolkit was developed to answer these types of questions.

Login to iMedicalApps in order to view the video review we made showing how to utilize the Anticoagulation Toolkit with patients, along with explaining key alternative apps physicians should be on the lookout for. Registration for iMedicalApps is free.

As our population ages and our diagnostic testing and imaging improve, we see more patients diagnosed with atrial fibrillation and/or recurrent venous thromboembolism. Frequently, these conditions and others like them require chronic oral anticoagulation. For decades, we have used vitamin K antagonists such as warfarin. Due to complex monitoring and dosage adjustments, drug interactions and potential side effects such as hemorrhagic stroke and gastrointestinal bleeding, patients and providers have always hoped an alternative to warfarin would come along.

Over the last few years, a multitude of target specific oral anticoagulants (TSOAC’s) for treatment of non-valvular atrial fibrillation and venous thromboembolism have been approved. These new medications range from direct thrombin inhibitors to Factor Xa inhibitors. TSOAC’s are not without their drawbacks (bleeding, lack of a specific antidote), but for many, they are a significant advance over warfarin.

So where should providers turn to find the latest information on warfarin and the TSOAC’s? The American College of Cardiology (ACC) has an outstanding app called Anticoag Evaluator that helps providers and patients calculate the need for oral anticoagulation while comparing the risks/benefits of the various treatments side by side. We previously reviewed that app here on iMedicalApps.

More recently, the University of Michigan working with anticoagulation clinics across the state and with insurer Blue Cross Blue Shield created a quality improvement website and medical app called MAQI2 Anticoagulation Toolkit. The purpose of the the app is to “provide practitioners with an up-to-date, reliable, and easy to use source of information for anticoagulation.”

The content of the Anticoagulation Toolkit is based on a number of published guidelines from the American Heart Association (AHA)/ACC, the European Society of Cardiology, the CHEST guidelines, and a number of clinical trials. All of this information has been distilled to a very user friendly point of care app.

Evidence based medicine

Anticoagulation Toolkit is an outstanding example of a statewide quality improvement project that can improve patient care well beyond the borders of Michigan. It provides evidence based medicine on anticoagulants at the point of care. It contains the most current evidence based calculators and dosing information on anticoagulation in an easy to use format that is well referenced.

What providers would benefit from this App?

Students, residents, mid-levels, Family Medicine, Internal Medicine, Emergency Medicine, Cardiology, anticoagulation clinic personnel. Any provider who prescribes or manages patients on anticoagulants.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

  • Price
    • Free
    • Easy to use, intuitive interface utilizing the standard of care calculators and treatments.
    • Graphics easily compare warfarin vs. aspirin vs. no treatment.
    • Comprehensive “toolkit” PDF built into the app with extensive hyperlinks.
  • Dislikes
    • Content on the TSOAC’s not a significant part of the app.
    • No ability to reset entire app at one time–each section must be reset individually.
    • “Toolkit” PDF not easily readable/scalable on iPhone.
    • Not available for Android
  • Overall

    An excellent, “must have”, tool to manage patients who require anticoagulation, especially those on coumadin. The app lacks some of the evidence based comparisons of ACC’s Anticoag Evaluator including more useful information on TSOAC’s. It’s unfortunate this app isn’t available for Google Play at this time as physicians using Android could get great utility from it.

  • Overall Score
  • User Interface

    Intuitive, built in calculators, nice graphics, good instructions built in.

  • Multimedia Usage

    App links to full anticoagulation toolkit with multiple hyperlinks as well as useful websites. Toolkit can be shared easily via message, email, printed, etc.

  • Price

    A great resource for free.

  • Real World Applicability

    Must have resource for anyone who treats patients requiring anticoagulation.

  • Device Used For Review

    iPhone 6 running iOS 8.3

  • Available for DownloadiPhoneiPad