Stroke is the leading cause of disability in adults around the world. One of the major causes is atrial fibrillation (AF) and our aging population is contributing to an epidemic of AF. Anticoagulation therapy is highly effective stroke prevention for AF patients and there have been major changes to the therapeutics options available with the introduction of novel oral anticoagulants "NOACs".
In some ways the novel anticoagulants are simpler than warfarin - no regular INR monitoring, fixed dose, less food and drug interactions etc. However, like any new drugs there are unfamiliar issues. Despite the lack of INR monitoring, regular clinical monitoring and assessment of creatinine clearance is critical as they all have significant renal excretion. There are p-glycoprotein and other interactions to watch out for. Management of these anticoagulants around the time of invasive procedures is clearly an important area and the "safe" time off drug varies with renal function and the risk level of the procedure. Even recognising that a patient is taking one of these new drugs can be an issue as most hospital protocols ask about warfarin but not dabigatran/Pradaxa, rivaroxaban/Xarelto and apixaban/Eliquis!
The management of bleeding complications remains a challenging area as no specific antidote is yet on the market and traditional factor replacement therapies have not been proven to work. The side effect profile does vary across the agents (eg dyspepsia with dabigatran) and there are drug-specific issues around the use of dosing aids and crushing tablets. AnticoagAF provides detailed information on the use of each of these novel anticoagulants with specific guidance on perioperative and bleeding management based on currently available guidelines and will be regularly updated as new information comes to light.
AnticoagAF, a simple but comprehensive iOS app developed by the Royal Melbourne Hospital Neuroscience Foundation is the prefect reference for clinicians who are considering what and when to prescribe and how to manage specific situations like surgery, bleeding and stroke thrombolysis.
AnticoagAF app is now available on iTunes for $1.99
Currently the app is only avialble on iOS, although an Android version may be available in future. Profits form the sale of this app go to the RMH Neuroscience Foundation supporting continuing stroke research.
This is a guest post from Dr Bruce Campbell, who authored the app, and who is a collegue and friend at Royal Melboure Hospital.