Uptake and Utilization of the Management of Anticoagulation in the Periprocedural Period App: Longitudinal Analysis

Abstract

BackgroundAnticoagulants are major contributors to preventable adverse drug events, and their optimal management in the periprocedural period is particularly challenging. Traditional methods of disseminating clinical guidelines and tools cannot keep pace with the rapid expansion of available therapeutic agents, approved indications for use, and published medical evidence, so a mobile app, Management of Anticoagulation in the Periprocedural Period (MAPPP), was developed and disseminated to provide clinicians with guidance that reflects the most current medical evidence.ObjectiveThe objective of this study was to assess the global, national, and state-level acquisition of a mobile app since its initial release and characterize individual episodes of use based on drug selection, procedural bleeding risk, and patient thromboembolic risk.MethodsData were extracted from a mobile app usage tracker (Google Analytics) to characterize new users and completed episodes temporally (by calendar quarter) and geographically (globally, nationally, and in the targeted US state of New York) for the period between April 1, 2016 and September 30, 2017.ResultsThe app was acquired by 2866 new users in the measurement period, and the users completed nearly 10,000 individual episodes of use. Acquisition and utilization spanned 51 countries globally, predominantly in the United States and particularly in New York State. Warfarin and rivaroxaban were the most frequently selected drugs, and completed episodes most frequently included the selection of high bleeding risk (4888/9963, 49.06%) and high thromboembolic risk categories (4500/9963, 45.17%).ConclusionsThe MAPPP app is a successful means of disseminating current guidance on periprocedural anticoagulant use, as indicated by broad global uptake and upward trends in utilization. Limitations in access to provider and patient-specific data preclude objective evaluation of the clinical impact of the app. An ongoing study incorporating app logic into electronic health record systems at participant health systems will provide a more definitive evaluation of the clinical impact of the app logic.

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

“… 2 , 19 Despite the evidence-based benefit of DOACs in the treatment of thromboembolism and AF, physicians and nurse practitioners involved in the management of anticoagulation are not always familiar with the most recent advances and recommendations. 10 Our study’s acceptance group had better renal function (creatinine clearance: 80.8 vs 71.0 mL/min, P = .0040) compared to the rejection group. In addition, acceptance of MAPPP app recommendations was higher in patients receiving OAC medications other than warfarin (P < .0001).…”

“…Previously, the MAPPP mobile app version in 2016 was associated with a 20% relative reduction in the 30-day postoperative ADE rate, although the observed effect could not be attributed directly to the app. 10 …”

“…In contrast, mobile and web-based apps have been shown to be effective CDS and guideline dissemination tools. 10 , 20 , 21 The MAPPP app development has been previously described and its objective was to reduce the rate of anticoagulant-associated ADEs. 10 Benefits include broad dissemination, remote updates according to newer guidelines, and tracking of utilization.…”

“… 10 , 20 , 21 The MAPPP app development has been previously described and its objective was to reduce the rate of anticoagulant-associated ADEs. 10 Benefits include broad dissemination, remote updates according to newer guidelines, and tracking of utilization. Notably, the American College of Cardiology (ManageAnticoag app) and University of Michigan (MAQI2 Anticoagulation Toolkit) have developed apps similar to the MAPPP app in order to facilitate appropriate periprocedural anticoagulation management.…”

“…The resulting output includes evidence-based recommendations regarding periprocedural anticoagulation interruption and timing, heparin bridging, and indicated laboratory monitoring, as well as timing and dosing scheme of postoperative anticoagulant reinitiation. 10 …”