Patricia Simino Boyce
(Lake Success, NY) March 30, 2016 –– A new, freely-available smart phone application and online tool developed by an IPRO-led coalition enables clinicians to easily determine whether, when, and how to stop and restart the use of warfarin and oral anticoagulants during elective surgery and other invasive procedures.
Creators of this unique app, known as “MAPPP” (Management of Anticoagulation in the Peri-Procedural Period), believe this is the first time evidence-based guidance on this critical topic has been made available in an easy-to-use smart phone application. Intuitively organized, the MAPPP app provides individualized patient guidance for management of anticoagulant medications based on patient thrombosis (blood clot) risk and specific procedural bleeding risk. The tool is available on the Apple App Store and the Android Market.
“While the medical literature contains expert guidance for the use of anticoagulants during invasive procedures, to our knowledge there has never been a simplified reference guide to anticoagulant use that clinicians can quickly refer to when planning these procedures,” said Clare B. Bradley MD, MPH, Senior Vice President and Chief Medical Officer, IPRO. “Our task force saw this need, and developed this useful tool.”
Surgery and invasive medical interventions increase the risk of bleeding, but withholding anticoagulants increases the risk of thrombosis due to the underlying conditions for which anticoagulation was originally prescribed. The MAPPP app helps clinicians guide their decision making in balancing these risks, and enables them to make more informed choices on whether and how to interrupt oral anticoagulation for elective procedures or surgeries. The tool also provides guidance on whether and how to “bridge” with injectable anticoagulants, such as low molecular weight heparin, in patients who are treated with warfarin who need temporary interruption during procedures. Additionally, the MAPPP app includes management of aspirin and other antiplatelet drugs during the peri-procedural period.
“We developed the MAPPP app in the hope that this easy to use tool will help prevent medication errors and adverse drug and procedure-related events in patients during the vulnerable period of time before, during, and after invasive medical procedures,” said Anne Myrka, RPh, MAT, Director, Healthcare Quality Improvement Program, who leads IPRO’s drug safety initiatives.
“The MAPPP clinical decision tool represents a state-of-the-art tool using the best available evidence to help clinicians navigate through a difficult but common clinical scenario: how to manage your patients on warfarin or a direct oral anticoagulant undergoing an elective surgery or procedure”, said internationally recognized anticoagulation expert Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, and the lead for the IPRO Peri-Procedural Task Force which is composed of leading physicians, pharmacists and nurses from throughout New York. Dr. Spyropoulos, who serves as Professor of Medicine at Hofstra Northwell School of Medicine and System Director of Anticoagulation and Clinical Thrombosis Services of Northwell Health, was a contributing author of the American College of Chest Physicians’ 2008 and 2012 guidelines on managing anticoagulants in the peri-procedural period and has published widely on the peri-procedural use of these medications.
The Task Force is part of IPRO’s New York State Anticoagulation Coalition, which is co-led by acclaimed anticoagulation experts Jack E. Ansell, MD, founder of the influential Anticoagulation Forum, and Elaine M. Hylek, MD, MPH, of Boston University School of Medicine.
IPRO leads the Medicare-funded Atlantic Quality Innovation Network (AQIN), the Quality Improvement Organization for New York, South Carolina and the District of Columbia. QIOs are independent organizations that contract with the Centers for Medicare & Medicaid Services to work collaboratively with healthcare providers and professionals in order to improve care for Medicare beneficiaries. The MAPPP project is part of IPRO’s “Preventing Oral Anticoagulant Adverse Events” initiative, which has engaged anticoagulation providers, patients, and caregivers to promote the use of best practices in order to achieve measurable improvements in anticoagulation care.
To use the web-based version or to download the app go to: http://mappp.ipro.org/.
This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network-Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINNY-TskC.3-16-05