This activity is supported by an independent educational grant from Bristol-Myers Squibb Company.

OVERVIEW

Warfarin and heparin have been the standard of care for patients with VTE for decades, but there are many challenges with using these agents. New oral anticoagulants reduce some of the concerns associated with warfarin therapy, in particular, because they can be taken orally and don’t require patient monitoring. However, patient history, comorbidities, and treatment guidelines need to be taken into careful consideration. These case-based interactive video case studies will assist hospitalists in raising their knowledge and competence with respect to providing clinically appropriate care for hospitalized patients with acute VTE (DVT and PE) for whom treatment with the newer anticoagulants is considered.

GOAL

The goal of this case-based interactive video activity is to provide clinical professionals who treat and manage hospitalized patients with VTE with the most up-to-date and current data in order to improve patient outcomes.

TARGET AUDIENCE

This activity has been designed to meet the educational needs of hospitalists and other internal medicine providers at hospitals who are involved in the perioperative care of patients with VTE. 

LEARNING OBJECTIVES

After completing the module, the participant will demonstrate the ability to:

• DESCRIBE the pharmacology, pharmacokinetic profiles, and special dosing recommendations for target-specific oral anticoagulants for (acute) treatment of VTE disease.
• EXPLAIN the clinical guidelines for treatment of acute VTE.
• ANALYZE the benefits and risks of anticoagulant therapies in patients who require treatment for VTE.
• IMPLEMENT strategies to enhance appropriate use of anticoagulant therapies in virtual VTE patient cases.

CME INFORMATION

Accreditation Statement:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Virginia School of Medicine, ASiM and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians

The University of Virginia School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits.^TM  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Release date: February 15, 2016.  Expiration date: February 15, 2019. 

Estimated time to complete activity: 30 minutes

FACULTY & FACULTY DISCLOSURES

Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.

The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.

All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.

The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.

Scott Kaatz, DO, MSc, FACP, FHM (Course Director)
Clinical Associate Professor of Medicine
Michigan State University
Hurley Medical Center
Flint, Michigan
Dr Kaatz reports serving as a consultant for Boehringer Ingelheim, Bristol-Meyers Squibb Company, Daiichi-Sankyo, Janssen Pharmaceuticals Inc; and Pfizer Inc; reports serving on a speakers' bureau, as a faculty member, or peer reviewer for Boehringer Ingelheim, Bristol-Myers Squibb Company, CSL Behring, Daiichi-Sankyo, and Janssen Pharmaceuticals, Inc; and for serving on the advisory committee/board for AC Forum, National Blood Clot Alliance Medical and Scientific Advisory Board, National Certification Board of Anticoagulation Providers, and the Thrombosis and Hemostasis Societies of North America. 

Bartho Caponi, MD (Peer Reviewer)
Clinical Assistant Professor
Division of Hospital Medicine
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Dr Caponi reports having no significant financial or advisory relationships with corporate organizations related to this activity.

The staff at ASiM reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.

Off-Label Product Discussion:
All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

SHM CONFLICT OF INTEREST DISCLOSURE POLICY

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

DISCLAIMER

The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only. The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.

INSTRUCTIONS

The following is an interactive case-based video module designed to help you gauge your basic knowledge of VTE and then direct you to specific areas you may need to focus on. It consists of 3 sections: a nondesignated pretest, the interactive activity, and a CME post-test and evaluation. All 3 sections must be completed to receive CME credit. Participants must receive a post-test score of 70% or higher to pass and will have 3 chances to do so. A certificate of participation will be available online immediately following successful completion of the activity.

^*Please note: Since this program was recorded, the International Society of Thrombosis and Haemostasis recently has determined that target-specific oral anticoagulants (TSOACs) — also known as novel oral anticoagulants (NOACs) — will be referred to as direct oral anticoagulants (DOACs).