Perioperative Bridging of Anticoagulant Therapy

Jason Shiffermiller, MD, MPH and Barbara Slawski, MD, MS, SFHM

Summary

Anticoagulant medications are commonly prescribed to patients in the United States for a number of medical problems. Interruptions in anticoagulation can result in severe adverse outcomes, including permanent disability and death, from arterial and venous thromboembolism. These medications, however, can also be associated with serious perioperative bleeding events. In fact, both bleeding and thromboembolic risks are amplified in the periprocedural period. This module addresses the risk of thromboembolism associated with periprocedural interruption of anticoagulation in patients with atrial fibrillation, a mechanical heart valve, or a history of venous thromboembolism. It is important for hospitalists, who are routinely asked to manage medically complex surgical patients, to understand the periprocedural management of anticoagulation. This module will guide the participant on the perioperative timing of anticoagulant interruption and on the potential need for perioperative bridging anticoagulation.

Goal

To provide hospitalists with current data and guidelines regarding perioperative management of anticoagulation with a focus on bridging anticoagulation.

Target Audience

This activity is designed for hospitalists and residents interested in the field of consultative medicine. No prerequisites required.

Learning Objectives

After completing the module, the participant should be able to:

  1. Determine whether perioperative interruption of anticoagulation is necessary.
  2. Chart the appropriate timing for preoperative cessation and postoperative resumption of anticoagulants.
  3. Understand the indications for bridging anticoagulation in three clinical situations.
    1. Patients with atrial fibrillation
    2. Patients with mechanical heart valves
    3. Patients with a history of venous thromboembolism
Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Statement Designation

The Society of Hospital Medicine designates this activity for a maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date & expiration date: 
Estimated time to complete: 2 hours

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.

Instructions

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Additional Information

Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit
Course opens: 
11/08/2018
Course expires: 
11/08/2021
Member cost:
$0.00
Your cost:
$0.00
Rating: 
0
Faculty & Disclosures
Authors

Barbara Slawski, MD, MS, FACP, SFHM
Professor of Medicine and Orthopedic Surgery
Medical Director, Froedtert Hospital Perioperative Services 
Chief, Section of Perioperative and Consultative Medicine, Department of Medicine 
Froedtert and Medical College of Wisconsin

Dr. Slawski reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Jason Shiffermiller, MD, MPH
Assistant Professor of Medicine
Associate Director of Co-management and Perioperative Hospital Medicine Service
Section of Hospital Medicine, Department of Internal Medicine
University of Nebraska Medical Center
Omaha, Nebraska

Dr. Shiffermiller reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Editors

Leonard Feldman, MD, FACP, SFHM
Associate Professor of Medicine 
Johns Hopkins University School of Medicine 
Urban Health Residency and Track Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Founding Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland

Dr. Feldman reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Kurt Pfeifer, MD, FACP, SFHM
Professor of Medicine
General Internal Medicine
Medical Director, Froedtert and Medical College of Wisconsin Eye Institute Perioperative Services
Medical College of Wisconsin
Associate Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Milwaukee, Wisconsin

Dr. Pfeifer reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Additional planners and faculty for this activity have no relevant relationships to disclose.

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.

Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Statement Designation

The Society of Hospital Medicine designates this activity for a maximum of 2.00 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit

Accreditation Period

Course opens: 
11/08/2018
Course expires: 
11/08/2021

Price

Member cost:
$0.00
Your cost:
$0.00
Please login or register to take this course.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Click START to begin.