Patricia Simino Boyce
IPRO-designed “MAP” Tool Addresses How to Handle Numerous Patient Situations, In Order to Reduce Risk of Both Excessive Bleeding and Formation of Blood Clots
LAKE SUCCESS, N.Y. – May 13, 2014 – A new, free-of-charge tool designed by the Peri-Procedural Task Force of the IPRO-led New York State Anticoagulation Coalition will enable clinicians to more easily determine how, whether and when to stop the use of warfarin and other anticoagulants prior to surgery and other invasive procedures such as colonoscopies. Creators of this unique tool, known as “MAP” (Management of Anticoagulation in the Peri-Procedural Period), believe it is the first time evidence-based guidelines on this critical topic have been distilled into an easy-to-use, single-page format.
The Task Force reviewed hundreds of pages of medical journal articles to create this unique reference tool. Organized in a series of sequential tables, the MAP tool gives multiple scenarios related to the use of anticoagulant medications, including levels of patient thrombosis (blood clot) risk and categories of bleeding risk. The reference guide can be downloaded from IPRO’s website and printed on a single sheet of 11” x 17” paper to provide clear guidance on how each individual case should be handled.
“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 MAP tool helps clinicians guide their decision making in balancing these risks, and enables them to make more informed choices on whether to interrupt oral anticoagulation for a medical procedure. The tool also provides guidance on, if anticoagulation is interrupted, whether to “bridge” with injectable anticoagulants, such as low molecular weight heparin in patients who are normally treated with warfarin.
The MAP tool addresses the complexity of managing anticoagulants – including warfarin and other novel agents now available, as well as the use of aspirin and other antiplatelet drugs before, during and after surgery and common interventional procedures that can sometimes cause blood loss.
“The MAP tool will be useful for surgeons, gastroenterologists, dentists, and other disciplines that routinely perform invasive procedures,” said Darren M. Triller, PharmD, Senior Director, Healthcare Quality Improvement Program, who leads IPRO’s drug safety initiatives.
Led by internationally recognized anticoagulation expert Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, the IPRO Peri-Procedural Task Force consists of leading physicians, pharmacists and nurses from throughout New York. Dr. Spyropoulos, who serves as Director of Anticoagulation Services and Clinical Thrombosis at North Shore-LIJ Health System at Lenox Hill Hospital, was a contributing author of the American College of Chest Physicians’ recently updated guidelines on managing anticoagulants and has published widely on the peri-procedural use of these medications.
IPRO’s New York State Anticoagulation Coalition 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 is New York State’s Medicare Quality Improvement Organization (QIO), an independent organization that contracts with the Centers for Medicare & Medicaid Services to work collaboratively with healthcare providers and professionals in order to help improve care for Medicare beneficiaries. The MAP 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.
Although just launched, the MAP tool has already been reviewed by the Anticoagulation Forum, the leading organization of anticoagulation professionals, and has been added to their “Anticoagulation Centers of Excellence” page, for use by member anticoagulation specialists across the United States.
To download a copy of the MAP tool, go to: http://qio.ipro.org/drug-safety/drug-safety-resources
IPRO is a national organization providing a full spectrum of healthcare assessment and improvement services that foster more efficient use of resources and enhance healthcare quality to achieve better patient outcomes. Founded in 1984, IPRO is highly regarded for the independence of its approach, the depth of its knowledge and experience, and the integrity of its programs. IPRO holds contracts with federal, state and local government agencies, as well as private-sector clients, in more than 33 states and the District of Columbia. A national not-for-profit organization, IPRO is headquartered in Lake Success, NY. For more information, visit ipro.org.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, 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. 101SOW-NY-AIM7.3-14-05