Coagulate concisely provides the timeframes for discontinuation of anticoagulant and antiplatelet medications prior to invasive procedures. Additionally, the app provides the American Society of Regional Anesthesia and Pain Management (ASRA) and European Society of Regional Anesthesiology (ESA) guidelines for regional anesthesia and anticoagulant reversal.
The Coagulate app offers anesthetists a quick reference for patients receiving NSAID, anticoagulant, or antiplatelet medications. When the app is first opened, an alphabetical list of 30 anticoagulant and antiplatelet medications appear. The medications are listed as either generic or their trade name. Additionally embedded in the list, are the "Herbals" and "Plexus and Peripheral Blockade" category options. After selecting the medication of choice, the app provides 4 categories of information:
- Stop Info
- ASRA Consensus Statement
- ESA Information
A quick link to the 4 categories is conveniently located in the top left corner of the screen. The "Stop Info" clearly provides a summary of the timeframe for discontinuation prior to surgery and neuraxial anesthesia. When appropriate, there is further detail concerning dosing of anticoagulants following spinal and epidural placement and the appropriate timeframe for epidural manipulation and removal. Where appropriate, optimal INRs are reported. For the emergent procedure, the "Reversal" section provides the user with the current suggestions for anticoagulant reversal. This sections is obviously only appropriate for certain medications. While anesthetists are familiar with then ASRA guidelines, the "ASRA Consensus Statement" portion provides detailed explanations. These guidelines vary, but in general include:
- Suggested anesthetic management
- Preoperative assessment foci
- Appropriate lab testing and acceptable values
- Risk of spinal hematoma (where appropriate)
- Postoperative anticoagulant initiation/resumption
- Detailed explanation of discontinuation timeframe
- The relationship of neuraxial anesthesia, anticoagulation status and neuraxial catheter removal
The final section consists of the ESA's guidelines. These guidelines provide the ESA's suggested anitcoagulant/antiplatlet withdrawal timeframe prior to puncture, catheter manipulation or catheter removal. It concludes with the suggested anticoagulant/antiplatelet resumption timeframe after catheter removal.
The Coagulate app addresses all invasive procedures, but has a focus on neuraxial puncture and catheter manipulation and/or removal. The risk of a spinal hematoma is extremely low; however, when it occurs the neurologic consequences can be profound. For this reason, the ASRA and ESA have provided guidelines to assist anesthesia providers in preventing said complication. Two factors anesthesia providers must consider in the prevention of spinal hematomas are:
- The pharmacological repertoire of anticoagulants and antiplatelets is constantly expanding with new highly-effective medications
- In the clinical setting, the ASRA and ESA resources are not always easily accessible nor in a concise format
For the later reason, the Coagulate app was developed. The app provides the most current (2010) ARSA and ESA guidelines. For $0.99 the resource is easily accessible in a clear and concise format on most smart phones or tablets. This resource allows providers to make evidence-based decisions about patients invasive procedures based on their coagulation status. Providers' time and concentration can be spent caring for their patients, rather than searching for information.
The Android "Coagulate" app has not been revised in over a year (May, 2012) and it has been nearly two and a half years (March, 2011) since a revision for the iProducts. Providers must keep this in mind when referencing the app, as there is the ever increasing testing and release of high-effective anticoagulant and antiplatelet medications.
For the price of $0.99, I highly suggest this app.
East to access information
- Somewhat infrequent medication updates