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Appropriate perioperative management of patients on chronic oral anticoagulation (OAC)-including warfarin and the direct oral anticoagulants-is a poorly defined yet important clinical issue with potentially severe consequences in the postoperative period. We sought to prospectively evaluate the effect of the Management of Anticoagulation in the Periprocedural Period (MAPPP) mobile app as a clinical decision tool in the management of patients on chronic OAC undergoing elective procedures or surgeries. Between January 1, 2018, and January 31, 2019, 642 patients treated in our health system were included. Eligible patients met the following criteria: age >18 years old, creatinine clearance ≥15 mL/min, and on chronic OAC with adequate information regarding baseline characteristics. Our study outcome was patient's emergency department (ED) visits within 30 days postprocedure. The MAPPP app was integrated into the electronic health record (EHR), and the end user was free to accept or decline recommended evidence-based perioperative anticoagulation management guidance. Analysis revealed that acceptance was more common in younger patients ( P = .0137), patients on oral anticoagulants other than warfarin ( P < .0001), and patients undergoing increased bleeding risk procedures ( P = .0068). Acceptance of the MAPPP app recommendation was significantly associated with fewer ED visits (acceptance group: 4.0% vs rejection group: 8.3%, P = .0205). Logistic regression showed that intervention acceptance and female gender were significantly associated with fewer-while age ≥80 with more-30-day ED visits. Our findings indicate that newer technologies, such as the MAPPP app, integrated into clinical EHR workflow, can significantly augment evidence-based perioperative anticoagulation management and potentially result in a reduction of adverse outcomes.

During the academic year 1958/59, a survey was made of interlibrary loan requests originating at Columbia University Medical Library. A high percentage of requests came from a relatively few requesters. However, analysis based on "one-time" and "repeat" categories for the patron and his requests indicated a situation less extreme than "monopoly use by an elite group." Requests were classed by type, age, language, title, etc., and were also correlated with such variables as citation source, requester's academic status and experience, and estimated importance of material. The analysis aims to uncover patterns significant for cooperative planning. Did the repeat and one-time requester show distinctive characteristics and habits? Which materials attracted more repeat requests? Findings generally favored cooperation, at least for a library servicing nonstudent researchers. Unpredictability of researchers' needs was noted. Apart from specific findings, this paper offers methods for statistical analysis of interlibrary loans.