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ForwardPerioperative Management of Anticoagulant Therapy
Lily Ackermann, MD, ScM, FHM
Annabel Frank MD
Margaret Fang MD, MPH
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 can also be associated with serious perioperative bleeding events. In fact, both bleeding and thromboembolic risks are amplified in the periprocedural period. Many patients undergo routine and emergent procedures, thus it is critical for hospitalists, who are routinely asked to manage medically complex surgical patients, to understand the periprocedural management of anticoagulation. There are many nuances to consider: not all patients are at the same risk of thromboembolism, not all procedures are associated with the same risk of bleeding, and the indications for “reversal agents” are complex. This module will guide the participant on the perioperative timing of anticoagulant interruption, the potential need for perioperative bridging anticoagulation, and address these nuances to better equip hospitalists for managing perioperative reversal.
Learning Objectives
After completing the module, the participant should be able to:
- Determine whether perioperative interruption of anticoagulation is necessary.
- Chart the appropriate timing for preoperative cessation and postoperative resumption of anticoagulants.
- Understand the indications for bridging anticoagulation in three clinical situations.
a. Patients with atrial fibrillation
b. Patients with mechanical heart valves
c. Patients with a history of venous thromboembolism
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 and a CME evaluation. All sections must be completed to receive CME credit.
Additional Information
| Attachment | Size |
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 References - Perioperative Management of Anticoagulant Therapy | 205.99 KB |
Authors
Lily Ackermann, MD, ScM, FHM
Annabel Frank MD
Margaret Fang MD, MPH
Barbara Slawski, MD, MS, SFHM
Editors
Leonard Feldman, MD, FACP, SFHM
Kurt Pfeifer, MD, FACP, SFHM
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.
CME 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 PointsSuccessful 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
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, 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.