NOTE: This module is currently in the process of being updated and recertified, and so does not currently offer CME. A fully updated module eligible for CME is expected to be available Summer 2024.

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

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

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 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.

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.