Anticoagulation Guidelines App – A Reference App to Rapidly Determine When to Stop Anticoagulants Prior to Procedures

We continue to see patients diagnosed with conditions which require anticoagulation and/or antiplatelet medications. Conditions such as coronary artery disease, stroke, non-valvular atrial fibrillation, new or recurrent venous thromboembolism, and mechanical heart valves frequently require lifelong use of these medications. In 2019, we have more options than ever before! In addition to aspirin, warfarin, and unfractionated heparin, we now have more than four FDA approved target-specific oral anticoagulants (TSOACs). Patients also take a multitude of supplements, some of which can also affect bleeding times.

Despite taking “blood thinners” daily, these patients still must undergo common procedures and surgeries. The multitude of medications affect bleeding time, when should a provider advise a patient to stop them? Proceduralists frequently will expect the patient’s primary care provider to perform a preoperative evaluation or at least advise the patient when to hold their medications if at all. Where can providers quickly find this information? One option for non-valvular atrial fibrillation is the outstanding American College of Cardiology’s Anticoag Evaluator. Another excellent option for non-valvular atrial fibrillation (and some general information on all anticoagulants) is the excellent MAQI2 Anticoagulation Toolkit from the University of Michigan. The CDC created an app that covers an even wider gamut of medical conditions requiring anticoagulation including VTE, fetal loss, HIT, and arterial thrombosis in addition to atrial fibrillation called CDC Anticoagulation Manager. A new app from Laurel Ridge Software designed for residents and fellows of a Pain Medicine physician, Dr. Cheryl Bernstein, MD, attempts to simply this information even further with a reference app that provides the time to stop an anticoagulation/antiplatelet medicine—and not much else. The app is actually written by an ophthalmologist, Dr. Aaron Sobol, who also created the Laurel Ridge Opioid Tool app.

Evidence-based medicine

Developed by Laurel Ridge Software specifically for residents and fellows who work with Dr. Cheryl Bernstein, MD, a pain medicine physician, Anticoagulation Guidelines has a simple singular focus: rapid access information on when to stop anticoagulation/antiplatelet medications. The app contains a simple “number” answer in days/hours of when to stop these medications prior to presumably pain medicine related procedures. The app lacks any references, links, or even directions on how to use the app/interpret the data; however, I think that is the point — rapid access is the goal — nothing more. The name of the app is misleading as no guidelines per se are included/discussed in the app.

Who would benefit from this medical app?

Nurses, students, residents, mid-levels, proceduralists, pain medicine providers, primary care providers, emergency medicine, internal medicine, and hospitalist providers — or any provider who prescribes/manages patients on anticoagulation.

Price

  • Free

Likes

  • Simple interface rapidly provides time to stop/hold anticoagulation medications
  • Comprehensive list of medications and supplements that can cause bleeding
  • App proceduralist/pain medicine specialist focused

Dislikes

  • Lacks information on medications, indications, when to restart, etc
  • No references, links, instructions on use
  • Not available for Android

Overall

Laurel Ridge Software’s Anticoagulation Guidelines is a bit of a misnomer. The shortened name on an iOS device is CoagStop and that is more appropriate since that is all this app does. For some, this is perfect: select the anticoagulant/antiplatelet and the app tells you when to stop the medication prior to a procedure. However, for most primary care providers we will want more information about the patient, medication and procedure and not just the number of days/hours to stop a medication. The app may be too simple for its own good with no links, references, or even instructions.

Overall Score

  • 4.0 stars

User Interface

  • 4.0 stars

There’s a basic interface where you select the medication and the app tells you when to stop it prior to a procedure.

Multimedia Usage

  • 3.0 stars

No-frills interface with no links, references, etc.

Price

  •  5 stars

The app is free.

Real World Applicability

  • 4.0 stars

Despite the app’s simplistic layout and complete lack of instructions, I can see providers using it to quickly determine when to stop anticoagulant and antiplatelet drugs prior to procedures. The issue is the lack of references, details on the medications, and the procedures in question. There are more complete options out there from CDC and others.

Device Used For Review

  • iPhone 8 running iOS 12.1.2

Available for Download for iPhone and iPad. Not available for Android at this time.

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.