Perioperative Management of Anticoagulation

Margaret C. Fang MD, MPH and Ivan de Kouchkovsky, MD

If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.

Summary

Current estimates indicate that 2 to 3 million Americans take anticoagulants for prevention of thromboembolism from venous thromboembolism, atrial fibrillation, or prosthetic heart valves. Invasive procedures are performed in as many as 250 000 patients taking anticoagulants on an annual basis in the United States. Consequently, management of anticoagulants in the perioperative period is a common and vexing challenge for physicians. Because not all patients are at the same risk of thromboembolism and not all procedures are associated with the same risk of bleeding, it is important for hospitalists to know how to weigh these risks in their patients. The purpose of this module is to review risk stratification for thromboembolism and bleeding associated with different thromboembolic disorders and invasive procedures.

Goal

To provide hospitalists with current evidence on recommended management of anticoagulants in the periprocedural period.

Target Audience

This activity is designed for hospitalists. No prerequisites required.

Learning Objectives

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

  1. Assess the risk of venous thromboembolism (VTE) associated with interruption of anticoagulation in patients with a history of VTE, deep venous thrombosis, or pulmonary embolism.
  2. Assess the risk of arterial thromboembolism (ATE) associated with interruption of anticoagulation in patients with atrial fibrillation.
  3. Assess the risk of ATE associated with interruption of anticoagulation in patients with mechanical heart valves.
  4. Formulate a plan for pre- and post-operative anticoagulation management in patients taking warfarin or direct oral anticoagulants (DOACs).
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.

Course 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.

Release Date: TBA, 2020

Expiration Date: TBA, 2020

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 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
  • 2.00 AMA PRA Category 1 Credit™
Course opens: 
03/27/2020
Course expires: 
03/27/2023
Member cost:
$0.00
Your cost:
$0.00
Rating: 
0
Faculty & Disclosures
Authors

Margaret C. Fang, MD, MPH
Medical Director, UCSF Anticoagulation Clinic
Professor of Medicine, Division of Hospital Medicine
The University of California, San Francisco
San Francisco, California

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

Ivan de Kouchkovsky, MD
Department of Medicine
The University of California, San Francisco
San Francisco, California

Dr. de Kouchkovsky 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
Founding Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Deputy Editor, Journal of Hospital Medicine
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 relationship 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 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
  • 2.00 AMA PRA Category 1 Credit™

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.

If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.