Reversal and Reinitiation of Anticoagulation

Mehraneh Khalighi, MD, Becca Engels, MD, Scott Kaatz, DO, MSc, SFHM, and Lily Ackermann, MD, ScM, FHM

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

Anticoagulation therapy is associated with increased risk of bleeding, including intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding, which occurs in up to 7% per patient years with an estimated overall mortality rate of 9%.1 Additionally, urgent surgery with increased bleeding complications in patients on oral anticoagulation appears to be common but has not been well studied.2 In this module, we review strategies to manage potentially life-threatening ICH and GI bleeding and minimize the risk of bleeding with urgent surgery in patients on oral anticoagulation.

Learning Objectives

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

  1. Recognize the mechanisms of action of available agents for reversal of anticoagulant effects of warfarin and direct-acting oral anticoagulants (DOACs).
  2. Summarize pertinent clinical studies comparing agents for reversal of anticoagulant effect.
  3. Understand strategies for rapid reversal of anticoagulation in ICH, GI bleeding, and before urgent surgery.
  4. Assess the risk of rebleeding after ICH and GI bleeding.
  5. Determine timing of anticoagulation resumption after ICH and GI bleeding.
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, and a CME evaluation. All sections must be completed to receive CME credit.

Additional Information

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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 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: 
07/31/2024
Course expires: 
07/30/2027
Member cost:
$0.00
Your cost:
$95.00
Part of: 
SHM Consults Core Curriculum
Rating: 
0
Authors

Mehraneh Khalighi, MD

Becca Engels, MD

Scott Kaatz, DO, MSc, SFHM

Lily Ackermann, MD, ScM, FH

Editors

Leonard Feldman, MD, FACP, SFHM

Kurt Pfeifer, MD, FACP, SFH

Disclosures

The faculty and planners of these activities have no relevant relationships to disclose unless denoted above. All relevant relationships were mitigated prior to the start of this activity.

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 mitigates 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 CreditsTM. Physicians should claim only 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 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 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:
$95.00
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, and 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.