Antithrombotic agents and invasive procedures

for iPhone and iPad



AnaPaed has been rejected by Apple!


Here is an overview of the currently available apps


The app-solute educational helper in antithrombotic medication and invasvie procedures. Includes 'bridging' and 'cardiovascular risk'.


Rejected by Apple: not available


Malignant hyperthermia (MH) ! This is the offical app of the European MH Group (EMHG) and the MH Association of the United States (MHAUS).

Congress app

Need an app for a smaller meeting ? This might be your solution. (currently iOS only and limited to a single lecture room).


These are the main features. See below for further details

NOTE CoaguSafe is not a substitute for medical advice. CoaguSafe is intended for educational purposes only.


Drugs interacting with the coagulation system can be listed by generic or brand name.

Drug groups

Drugs are grouped according to their mode of action. Learn about monitoring and antagonism.


Suspension of the drug before invasive procedures in a list and detail view.



Learn about thromboembolic risk, information about briding up to the procedure.

Cardiovascular risk

Learn about cardiovascular and surgical bleeding risk.


Several international, national and also local guidelines can be selected.


the app-solute educational helper for antithrombotic agents and invasive procedures

NOTE CoaguSafe is not a substitute for medical advice. CoaguSafe is intended for educational purposes only.

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When to pause an antithrombotic agent ?

CoaguSafe has a list of most antithrombotic agents. These can be sorted by generic or brand name. Recommendations for pausing (according to international guidelines) are already visible in list view. The detail view expands on high- or low-risk procedures and - if appropriate - on renal insufficency.

Each drug belongs to a drug class, i.e. thrombin inhibitors, FXa inhibitors, glycoproteine IIbIIIa inhibitors and others. Mode of action and monitoring is described for each group.

For iPhone and iPad

On warfarin or new oral anticoagulant ?

Oral anticoagulation has to be suspended for many invasive procedures. There might be a need of 'bridging' with low molecular weight heparin (LMWH), dependent on the thromboembolic profile.

The thromboembolic profile is dependent on:

  • Valvular risk factors
  • Atrial fibrillation and CHADS2 VA2Sc score
  • Probability of venous thromboembolism

Management of the new oral anticoagulants (NOAC) is frequently dependent on renal function. Therefore renal function is also accounted for.

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Cardiovascular and bleeding risk?

Pausing antithrombotic drugs is important before invasive procedures are performed. On the other hand there are situations in which such suspension of antithrombotic agents might not be recommended.

Learn about cardiovascular risk (e.g. recent coronary stents - bare metal or drug-eluting) as well as bleeding risk of the invasive procedure.

Based on these two estimations suggestions of the guidelines are presented.


CoaguSafe is based on international and national guidelines. After selection of a guideline the respective recommendations are presented. If a specific drug is not included in the selected guideline, then alternative recommendations are shown (and labelled with an asterix).

The following guidelines are currently included:

  • American society of regional anesthesia and pain therapy (ASRA)
  • Deutsche Gesellschaft für Anästhesie und Intensivmedizin (DGAI)
  • European society of anaesthesiology (ESA)
  • Kantonsspital St. Gallen
  • United Kingdom (AAGBI, OAA, RA-UK)
  • Österreichische Gesellschaft Anästhesiologie, Reanimation und Intensivmedizin (ÖGARI)

Should a particular guideline be missing, then drop me an email. On specific request local guidelines can also be included.

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optimized for iPhone and iPad

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AnaPaed - Rejected by Apple

AnaPaed was rejected by Apple and is not available anymore!

In April 2015 Apple rejected the iOS 8 update of AnaPaed due to a new rule 22.9. of the developer guidelines

22.9 - Apps that calculate medicinal dosages must be submitted by
the manufacturer of those medications or recognized institutions such as hospitals, insurance companies, and universities

Following this rejection I have removed all calculations and AnaPaed was just showing static dosage (mg/kg bodyweight).
I then resubmitted the app to Apple. It was a surprise - and disappointment to go through the following

Apple: rejected: We noticed that your app includes features that calculate medical dosages

Myself: Thank you for your review. Your reason for rejection is wrong. I have been communicating with the review team since almost two months. The app has been changed in order NOT to calculate dosages (see comments in the app, the metadata and communication with the review team).

Apple: Unfortunately we can only accept medical dosage calculators submitted by the manufacturer (....) It would be appropriate to address this issue.

Myself: I think this is a misunderstanding. To calculate a dosage I have to multiply body weight by dose/kg. This was the functionality of the App before the rejection in April.(...) We then discussed to remove the dosage calculation and replace it with dose information (mg/kg). That is what the app does now. (...) There is no dosage calculation.

Apple: Upon further review, we still find the previous rejections to be valid. Please commit any changes to the app binary, and resubmit for review.

Myself: It is just a fact that the app does not calculate dosage. Please escalate this. Thank you

Apple: It would be appropriate to make sure your app is compliant with the 22.9 guideline.

Myself: Thank you for your reply, which - I must admit - is not very helpful. In April I am told to remove dosage calculation and change to static dosing information in order to be compliant with 22.9 After changing the app accordingly I am again told to remove something which is not there. This is obviously impossible. (...)


optimized for iPhone and iPad

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