European VTE Guidelines Now Mobile

The care of perioperative patients is likely out of the scope of practice for many of us in primary care except for those who perform hospitalist work and/or C-sections/completed advanced fellowship training. Nonetheless, the danger of venous thromboembolism is especially great in the perioperative period.

Typically VTE prophylaxis is prescribed by the anesthesia provider or the surgeon, but primary care providers/hospitalists may also be consulted for recommendations especially for complex inpatients requiring surgery. The timing of when to start/stop prophylaxis continues to evolve especially in the NOAC age.

In 2018, the European Society of Anaesthesiology (ESA) released their updated VTE prophylaxis guidelines. These guidelines advise the treatment of obese patients, pregnant patients, the elderly, neurosurgical patients, thoracic, and cardiovascular surgery patients, intensive care patients, etc.

The app also addresses the use of inferior vena cava (IVC) filters, aspirin, and mechanical prophylaxis. The guidelines have been adopted by numerous European organizations including the European Society of Intensive Care Medicine (ESICM), the European Association of Urology (EAU), the European Digestive Surgery (EDS), the European Board of Colleges of Obstetrics and Gynaecology (EBCOG), the European Knee Society (EKS), the European Hip Society (EHS), etc.

The app developer ESCAVO has taken the executive summary of the guidelines and created a useful mobile app. Here at iMedicalApps our previous “go-to” sepsis apps have been from ESCAVO including ESCAVO Sepsis and Sepsis Timer. With ESA VTE Prophylaxis, ESCAVO takes many of the design features that have made their sepsis apps extremely popular to bring to life the ESA VTE guidelines. The app covers all 12 chapters of the guideline with clear recommendations, evidence criteria, links to PubMed articles, and useful VTE related calculators.

Evidence-based medicine
The app contains the executive summary of the 2018 ESA VTE Prophylaxis guidelines for perioperative patients. The guidelines consist of evidence-based and expert-based recommendations.

Most of the app sections include the GRADE of each recommendation and a workable hyperlink to the PubMed references. The app also contains several evidence-based calculators. The app includes appropriate disclosures of some of the guideline’s authors. The guideline has been adopted by numerous European organizations. Much of the content is likely appropriate for U.S. patients but differences in recommendations between respective societies do exist.

What providers would benefit from this App?
Students, residents, nurses, mid-levels, anesthesia providers, surgeons, hospitalists, and any provider who treats perioperative patients at risk for VTE.

Price
o Free

Likes
o Covers all 12 chapters of the ESA VTE guideline including calculators and references
o Handy sections for bookmarks, notes, and global search functions
o Available for Android

Dislikes
o Executive summary of guidelines only included
o Unclear how recommendations established — contains a lot of “we suggest” text
o Not all sections give clear recommendations on what to prescribe for prophylaxis

Overall
An excellent app by ESCAVO which brings the 2018 ESA VTE prophylaxis guidelines to mobile. The app covers the perioperative gamut from obese patients and pregnancy to IVC filters. The app is well-referenced, easy to follow, and contains several helpful calculators. However, it only contains the executive summary of the guidelines with hyperlinks to the entire guideline. Certainly worth downloading for our European readers who care for perioperative patients.

Overall Score
o 4.5 stars

User Interface
o 5.0 stars
Easy to use interface designed by ESCAVO.

Multimedia Usage
o 4.5 stars
App contains a detailed reference section, embedded references, links to the full guideline, several calculators, and easy to follow algorithms in various sections of the app.

Price
o 5 stars
App is free.

Real-World Applicability
o 4.0 stars
Obviously not as applicable in the U.S., but certainly for our European readers. Nonetheless, the app is still somewhat limited in scope. However, the app is well-designed, easy to use, and brings an important guideline to providers in app form. ESCAVO makes great apps and this is another example of their outstanding design. We need an app like this for U.S. guidelines.

Available for iPhone, iPad, and Android.

Device Used For Review
o iPhone 8 running iOS 12.3.1

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.