MAPPP!
Welcome to IPRO's Management of Anticoagulation in the Peri-Procedural Period app.
MAPPP app is referenced in the Perioperative Management of the Antithrombotic Therapy, CHEST Guideline. Volume 162, Issue 5, E207-E243, November 1, 2022 as an online tool to help improve standardization of perioperative anticoagulant management.
Click here to try the web-based version now!
Despite the considerable efficacy of antithrombotics and the increased number of oral anticoagulants now available, preventable bleeding and thrombotic events are still unacceptably common. While recently marketed agents require less laboratory monitoring, problems with the clinical management of anticoagulated patients persist, particularly in the peri-procedural period.
Surgery and invasive medical interventions increase the risk of bleeding, while withholding anticoagulants increases the risk of thrombosis due to the underlying condition(s) for which anticoagulation was originally prescribed. The clinical team must therefore balance these competing risks and make educated decisions regarding the decision to interrupt oral anticoagulation for a medical procedure and, if interrupted, whether to "bridge" anticoagulation with injectable anticoagulants, such as low molecular weight heparin (LMWH) in warfarin treated patients.
This guide is intended to:
- Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis
- Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant "bridging"
- Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period
- Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures
This material was created by the multidisciplinary members of the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and 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. 10SOW-NY-AIM-7.3-14-01
Browser Requirements
To view this app in your browser properly, you must have Javascript enabled as well as use one of the supported browsers:
- Google Chrome - latest version
- Mozilla Firefox - latest version
- Microsoft Internet Explorer - version 10+
- Microsoft Edge - version 12+
Patient Education Materials
The patient education materials below provide information for patients on managing their anticoagulation therapy before, during, and after planned or elective surgical or invasive procedures. These materials can be used for patient education and knowledge assessment in any healthcare setting and were produced in collaboration with The National Blood Clot Alliance.
Understanding anticoagulant risk prevention when surgery or other procedures are planned. - A patient’s guide to understanding their anticoagulation regimen may be altered due to a surgery or procedure. Additionally, the bottom of the form is for the patient to record their specific directions from the clinician.
Anticoagulation management: What to expect when surgery or other medical or dental procedures are planned. - A comprehensive description of anticoagulants and their use in patients, including before, during, and after procedures.
A quick reference of anticoagulation management, what to expect when surgery or other medical or dental procedures are planned. – A one page summary of the above comprehensive description.
Patient knowledge assessment. - After reading the educational materials about anticoagulation management when surgery or invasive procedures are planned, test your knowledge by answering the questions below. Share the results with your doctor or other healthcare provider.
For more patient centered information about blood clots:
The National Blood Clot Alliance
A non-profit, patient-led, voluntary health organization dedicated to advancing the prevention, early diagnosis and successful treatment of life-threatening blood clots.
Stop The ClotAbout IPRO
IPRO is a non-profit organization that works with government agencies, providers and patients to implement innovative programs that bring policy ideas to life. For 35 years we’ve made creative use of clinical expertise, emerging technology and data solutions to make the healthcare system work better. IPRO holds contracts with federal, state and local government agencies, as well as private-sector clients, in more than 34 states and the District of Columbia. IPRO is headquartered in Lake Success, NY and also has offices in Albany, NY; Hamden, CT; Morrisville, NC; Hamilton, NJ; Beachwood, OH; and San Francisco, CA.
IPRO’s staff of more than 400 professionals includes physicians, registered nurses, mental health professionals, epidemiologists, biostatisticians, data analysts, medical record reviewers, health policy experts, pharmacists, coding professionals, claims analysts, auditors, programmers, systems analysts, web technology experts and healthcare communications specialists. IPRO also retains a network of more than 300 board-certified physician consultants.
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