Mitigating Stroke Risk Across the Continuum of Care: The Role of Targeted Oral Anticoagulants in Atrial Fibrillation
Release Date: August 11, 2014
Last Reviewed: July 24, 2014
Expiration Date: August 11, 2015
Time to Complete Activity: 1.0 hour

*This activity expired for credit on August 11, 2015 and is no longer available for credit
This activity is sponsored by Global Education Group.  Paradigm Medical Communications, LLC is the educational partner.


Charles V. Pollack, Jr., MA, MD, FACEP, FAAEM, FAHA (Chair)
Department of Emergency Medicine
Perelman School of Medicine
University of Pennsylvania
Department of Emergency Medicine
Pennsylvania Hospital
Philadelphia, PA
John Fanikos, RPh, MBA
Director of Pharmacy, Business
Brigham and Women’s Hospital
Boston, MA
Gerald V. Naccarelli, MD, FACC, FAHA, FHRS
Bernard Trabin Chair in Cardiology
Professor, Department of Medicine
Chief, Division of Cardiology
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
Penn State Hershey Heart and Vascular Institute
Hershey, PA
Target Audience
This activity has been designed to address the educational needs of clinicians specializing in cardiology, neurology, emergency medicine, internal medicine, family medicine, hospital medicine, and allied health professionals who manage patients with nonvalvular atrial fibrillation at risk for stroke.
Statement of Need
Atrial fibrillation (AF) is a growing health concern with a prevalence that is expected to increase over the next several decades. An important potential complication of AF is stroke and systemic embolism, which tend to cause greater morbidity and mortality than stroke not related to AF. Therefore, it is important that patients with AF who are at risk of having a stroke receive preventive treatment, which is best achieved by anticoagulation. Warfarin has been the oral anticoagulant (OAC) of choice for over 50 years; however, 3 target-specific OACs have been approved by the US Food and Drug Administration over the past 5 years and more are in the pipeline, providing much-needed options in anticoagulation. Despite the importance of stroke prevention in this at-risk population and the introduction of new agents, anticoagulation remains underused. In addition, although the target-specific OACs may have benefits over warfarin, many clinicians are not familiar with the subtle differences among the various agents and how to determine which agent is best for an individual patient. Healthcare providers who manage patients with AF who are at risk for stroke need a multidisciplinary overview of stroke prevention in AF, including an overview of how to identify patients who are at risk for stroke and should receive anticoagulation, evaluating the data that indicate the best use of the target-specific OACs, and safety considerations to ensure the most optimal, evidence-based application of these agents.
Learning Objectives
Upon proper completion of this activity, participants should be better able to:
·Delineate strategies to determine whether patients with AF are appropriate candidates for anticoagulation.
·Apply current evidence from clinical trials, evidence-based guidelines, and product information to select an appropriate anticoagulant for patients with AF.
·Describe evidence-based strategies for monitoring patients taking target-specific OACs.
·Explain approaches that can ensure safe and effective use of anticoagulation therapy across the continuum of care.
Table of Contents
  • Faculty
  • Introduction
  • Atrial Fibrillation: Definition and Epidemiology
  • Stroke Prevention in Atrial Fibrillation
  • Oral Anticoagulant Agents
  • Pharmacokinetics and Pharmacodynamics of OACs
  • Measuring the Degree of Anticoagulation
  • Reversal of Anticoagulants
  • Shared Decision Making
Physician Accreditation Statement
Global Education Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Physician Credit Designation
Global Education Group designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For information about the accreditation of this program, please contact Global at (303) 395-1782 or
Disclosure of Commercial Support
This activity is supported by educational grants from Boehringer Ingelheim Pharmaceuticals, Inc. and Daiichi Sankyo, Inc.
Instructions for Participation
To receive a CME certificate of participation, participants must:
  • Follow instructions to register or log in with your professional information and complete the pre-activity assessment.
  • View the online activity in its entirety.
  • Complete and submit the online posttest and evaluation. You must answer 70% of the posttest questions correctly to earn credit. You will have unlimited opportunities to successfully complete the posttest.
  • A certificate of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.

For questions regarding CME credit, contact the Paradigm CME Department at (845) 398-5949.
There is no fee required for participation in this activity.

Hardware/Software Requirements
This certified CME activity is designed using HTML5 audio.
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Disclosure and Resolution of Conflict of Interest
Global Education Group (Global) and Paradigm Medical Communications, LLC (Paradigm) require instructors, planners, managers, and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity.  All identified conflicts of interest are thoroughly vetted by Global and Paradigm for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. 
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Name of Faculty or Presenter
Reported Financial Relationship
Charles V. Pollack, Jr., MA, MD, FACEP
Consultant: Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb; Daiichi Sankyo, Inc; Janssen Pharmaceuticals, Inc; Pfizer Inc
John Fanikos, RPh, MBA
Consultant: Boehringer Ingelheim Pharmaceuticals, Inc
Gerald V. Naccarelli, MD
Consultant/Honoraria: BioSense-Webster; Bristol-Myers Squibb;  Daiichi Sankyo, Inc ; Glaxo-Smith-Kline; Janssen Pharmaceuticals, Inc; Otsuka Pharmaceutical; Pfizer Inc; Sanofi-Aventis: Xention
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Name of Planner or Manager
Reported Financial Relationship
Ashley Marostica, RN, MSN
Nothing to disclose
Amanda Glazar, PhD
Nothing to disclose
Amanda Hodges
Nothing to disclose
­­­­Paradigm Medical Communications, LLC (Paradigm) staff members have no financial conflicts to disclose.
Independent peer reviewer has no financial conflicts to disclose.
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