As the population ages, we continue to see more patients diagnosed with atrial fibrillation. Some are even calling the increase in atrial fibrillation diagnoses an epidemic. Frequently, these patients require chronic oral anticoagulation. For decades, we have use 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 nonvalvular atrial fibrillation 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 for some), but for many, they are a significant advance over warfarin.

To aid providers caring for patients on anti-platelet and anticoagulants, the American College of Cardiology (ACC) has been producing some outstanding apps. Previously on iMedicalApps we reviewed their outstanding Anticoag Evaluator and DAPT calculator apps. An additional resource is the excellent MAQI2 Anticoagulation Toolkit from the University of Michigan and insurer Blue Cross Blue Shield. How should providers handle patients with nonvalvular atrial fibrillation on anticoagulation who require procedures or surgery? Should the anticoagulation be interrupted and if so when? When can it be restarted? Should anyone be bridged with heparin or low-molecular weight heparin anymore? BridgeAnticoag takes the latest ACC guidelines on the topic combined with recent literature to create a point of care app to help providers with these difficult decisions.

Clinical Scenario

A 65 year-old female with a past medical history of hypertension and nonvalvular atrial fibrillation on apixaban with normal renal function presents to clinic for a preoperative evaluation. The patient is undergoing a laparoscopic hysterectomy for fibroids. When should her anticoagulation be interrupted? When should it be restarted? What if the patient was on warfarin? Does she need to be bridged?

Video Review of the BridgeAnticoag medical app:

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Evidence based medicine

ACC BridgeAnticoag app takes current ACC guidelines and combines them with clinical trial data including the recent bridge trial to assist providers in managing patients with nonvalvular atrial fibrillation on anticoagulation who require procedures/surgery. It provides an evidence based calculator for assisting providers in deciding if/when to stop anticoagulation, when to restart and who to bridge, all at the point of care.

What providers would benefit from the BridgeAnticoag medical app?

Students, residents, mid-levels, Family Medicine, Internal Medicine, Emergency Medicine, Cardiology, anticoagulation clinic personnel. Any provider who prescribes or manages patients on anticoagulation, performs procedures/surgeries, and/or preop clearance.

bridgeanticoag app

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 for data input.
    • Evidence based outcome data with clear recommendations on stop/start times.    
    • Extensive additional resources linked within app.
    • Available for Android
  • Dislikes
    • Medical App doesn’t include NNT/NNH or recent bridging studies just ACC CPG recs.
    • Additional resources all internet based; nothing local in app.
    • Minimal instructions on use of app.
  • Overall

    ACC BridgeAnticoag is a “must have” app to assist in the management of nonvalvular atrial fibrillation on anticoagulation patients who may need their anticoagulation interrupted or bridged prior to procedures/surgery. The medical app is similar to its siblings, Anticoag Evaluator and DAPT Calculator apps, but it lacks some of the finer EBM data points such as NNT/NNH. The app is available for both iOS and Android platforms.

  • Overall Score
  • User Interface

    Intuitive, built in calculator, but minimal instruction.

  • Multimedia Usage

    App links to various ACC resources, CPGs, etc. but all are internet links; no local content.

  • Price

    A great resource for free.

  • Real World Applicability

    A must have app for anyone who treats patients on anticoagulation and either performs procedures and/or performs preoperative clearance.

  • Device Used For Review

    iPhone 6S running iOS 10.3

  • Available for DownloadAndroidiPhoneiPad