Key Updates in Managing Oral Anticoagulation and its Reversal
 
NOAC Practice Updates from the European Society of Cardiology Congress 2015 and the American Heart Association Scientific Sessions 2015
 
Release Date: January 22, 2016
Last Reviewed: December 22, 2015
Expiration Date: January 22, 2017
Time to Complete Activity:  1.0 hour

*This activity expired for credit on January 22, 2017 and is no longer available for credit

Jointly provided by
           
 
Faculty
Charles V. Pollack Jr, MA, MD, FACEP, FAAEM, FAHA, FCPP
Associate Provost for Innovation in Education
Thomas Jefferson University
Director, Jefferson Institute of Emerging Health Professions
Associate Dean for CME and Strategic Partner Alliances, Thomas Jefferson University
Professor and Senior Advisor for Interdisciplinary Research and Clinical Trials
Department of Emergency Medicine
Sidney Kimmel Medical College of Thomas Jefferson University
Philadelphia, PA
 
Jeffrey I. Weitz, MD, FRCP(C), FACP
Professor of Medicine and Biochemistry
Division of Hematology and Thromboembolism, Department of Medicine
Executive Director, Thrombosis & Atherosclerosis Research Institute
McMaster University
Hamilton, Ontario, Canada
 
Additional Contributors
Mark Crowther, MD, MSc
Chair, Department of Pathology and Molecular
St Joseph’s Hospital and McMaster University
Hamilton, Ontario
 
Menno V. Huisman, MD, PhD
Leiden University Medical Center
Leiden, Netherlands
 
Elaine M. Hylek, MD, MPH
Professor of Medicine
Boston University School of Medicine
Boston MA
 
Jerrold H. Levy, MD, FAHA, FCCM
Professor of Anesthesiology
Associate Professor of Surgery
CoDirector, Cardiothoracic ICU
Duke University School of Medicine
Durham, NC
 
Gregory Lip, MD, FRCP, DFM, FACC, FESC
Professor of Cardiovascular Medicine
University of Birmingham, United Kingdom
Visiting Professor of Haemostasis Thrombosis and Vascular Sciences
Aston University, Birmingham, United Kingdom
Adjunct Professor in Cardiovascular Sciences
Aalborg University, Denmark
Visiting Professor of Cardiology
University of Belgrade, Serbia
 
Christian T. Ruff, MD, MPH
TIMI Study Group
Cardiovascular Division
Brigham and Women's Hospital
Harvard Medical School
Boston, MA
 
Target Audience
This activity has been designed to address the educational needs of hospital-based clinicians specializing in emergency medicine, intensive care, neurology, hospital medicine, cardiology, other internal medicine specialties and subspecialties, general surgeons, trauma surgeons, neurosurgeons, and acute care nurses, as well as clinical pharmacists. This activity will also benefit other healthcare providers interested in the optimal management of patients with or at risk for developing thrombosis.
 
Learning Objectives
Upon proper completion of this activity, participants should be better able to:
  • Identify the appropriate coagulation tests for assessing the extent of anticoagulation by the oral anticoagulants while considering the limitations associated with each coagulation test.
  • Review current strategies for the optimal management of patients who present with warfarin- or newer oral anticoagulant-related bleeding.
  • Evaluate the latest data of emerging strategies and antidotes for reversing the anticoagulation effects of warfarin and the non-warfarin oral anticoagulants.
 
Table of Contents
Anticoagulation Reversal in 2016: State of the Art
Mark Crowther, MD, MSc
 
Assessing Anticoagulation Intensity in NOAC-Based Therapy 
Charles V. Pollack, Jr, MA, MD, FACEP, FAAEM, FAHA, FESC
 
Updates from 2015 European Society of Cardiology Meeting
  • Dabigatran Reversal in Preprocedural Patients with Idarucizumab: Interim Results from RE-VERSE AD
    Jerrold H. Levy, MD, FAHA, FCCM
  • Education to Increase Adherence to NOACs Has No Effect in First 6 Months of Therapy
  • GLORIA-AF Registry Update from ESC
 
Updates from the 2015 American Heart Association Meeting
  • Andexanet Alfa Passes Another Test in Volunteers
  • Reinitiating Antithrombotic Therapy After Reversal of Dabigatran With Idarucizumab
  • Large Database Reveals New-Start NOACs in Atrial Fibrillation Have Less Bleeding Than Patients on Warfarin
 
Physician Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Paradigm Medical Communications, LLC and the Hospital Quality Foundation. Paradigm Medical Communications, LLC is accredited by the ACCME to provide continuing medical education for physicians.
 
Physician Credit Designation Statement
Paradigm Medical Communications, LLC 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.
 
Pharmacist Accreditation and Credit Designation Statements
Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 1 hour (0.1CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test.   Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.
 
UAN  #  0761-9999-15-297-H01-P
  
This is a knowledge-based activity.
 
Disclosure of Commercial Support
This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc. and CSL Behring.
 
Instructions for Participation
To receive CME/CPE credit, you should:
  • 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/statement of completion will be available for download/printing immediately following your successful completion of the posttest and evaluation.

Please note: to claim CPE credit, please make sure you include your date of birth and NABP number. All credit information will be uploaded into CPE Monitor within 30 days.

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

Hardware/Software Requirements
Portions of this certified CME/CPE activity are designed using HTML5 video. If you are using Internet Explorer 8, you will instead require the use of Adobe Flash Player.

Supported Browsers:
For Desktops (Windows/Mac)
Internet Explorer 8 or higher, Firefox 28 or higher, Safari 5.1 or higher, Google Chrome 31 or higher, Opera 21 or higher

For Tablets (iPad/Android/Surface)
iOS Safari 4 or higher, Android 2.3 or higher, IE Mobile 10 or higher

Technical Support: If you have any technical problems or playback issues email us at contactus@paradigmmc.com.
 
Disclosures
In accordance with ACCME and ACPE requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below.
 
Charles V. Pollack Jr, MA, MD, FACEP, FAAEM, FAHA, FCPP
Consulting Fees: Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company/Pfizer Inc; Daiichi Sankyo, Inc; Janssen Pharmaceuticals, Inc
Grant Recipient: AstraZeneca
 
Jeffrey I. Weitz, MD, FRCP(C), FACP
Consultant: Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc; ISIS Pharmaceuticals; Janssen Pharmaceuticals, Inc; Portola Pharmaceuticals, Inc; Pfizer Inc
 
Mark Crowther, MD, MSc
Consultant/Advisory Board: Portola Pharmaceuticals, Inc, Boehringer Ingelheim Pharmaceuticals, Inc
Speaker: Boehringer Ingelheim Pharmaceuticals, Inc
 
Menno V. Huisman, MD, PhD
Consulting Fees: Bayer HealthCare, Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb Company/Pfizer Inc
Contracted Research: Bayer HealthCare, Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb Company/Pfizer Inc
 
Elaine M. Hylek, MD, MPH
Consultant: Armetheon, Inc; Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc; Janssen Pharmaceuticals, Inc; Medtronic; Portola Pharmaceuticals, Inc; Pfizer Inc
 
Jerrold H. Levy, MD
Advisory Board: Boehringer Ingelheim Pharmaceuticals, Inc; CSL Behring; Grifols; Instrumentation Laboratories; Janssen Pharmaceuticals, Inc
 
Gregory Lip, MD
Consultant: Bayer HealthCare/Janssen Pharmaceuticals, Inc, Astellas, Merck & Co, Inc, sanofi-aventis, Bristol-Myers Squibb Company /Pfizer, Biotronik, Medtronic, Portola Pharmaceuticals, Inc, Boehringer Ingelheim Pharmaceuticals, Inc, Microlife and Daiichi Sankyo, Inc
Speaker: Bayer HealthCare, Bristol-Myers Squibb Company/Pfizer, Medtronic, Boehringer Ingelheim Pharmaceuticals, Inc, Microlife, Roche and Daiichi Sankyo, Inc
 
Christian T. Ruff, MD, MPH
Consultant: Bayer HealthCare; Boehringer Ingelheim Pharmaceuticals, Inc; Daiichi Sankyo, Inc, Portola Pharmaceuticals, Inc
Research/Grant Support: AstraZeneca, Daiichi Sankyo, Inc, Eisai, Inc, GlaxoSmithKline, Intarcia Therapeutics, Inc.
 
Paradigm Medical Communications, LLC staff members have no financial relationships to disclose.
 
Educational Review Systems, Inc. staff members have no financial relationships to disclose.
 
Independent peer reviewer has no financial relationships to disclose.
 
Resolution of Conflict of Interest
Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc. have implemented a system to resolve conflicts of interest for each CME/CPE activity to help ensure content objectivity, independence, fair balance, and that the content is aligned with the interest of the public. Conflicts, if any, are resolved through one or more processes. All CME/CPE content in this activity was independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance and the ACPE and ACCME’s Standards for Commercial Support of Continuing Medical Education.
 
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.
 
Disclaimer
This CME/CPE activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by Paradigm Medical Communications, LLC, Hospital Quality Foundation, or Educational Review Systems, Inc. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

If included, signed statements of informed consent granting permission for publication have been obtained for all photographs and videos in which an individual can be identified.
 
Terms of Use and Privacy Policy
Disclaimer
The materials provided for this activity are for informational purposes only, and should not be used for diagnosis or treatment of a health problem without consulting a licensed medical professional. Any views or opinions presented are solely those of the faculty, and do not necessarily represent those of Paradigm Medical Communications, LLC, Hospital Quality Foundation, or Educational Review Systems, Inc. References to any entity, product, service, or source of information on this website should not be considered an endorsement, either direct or implied, by Paradigm Medical Communications, LLC, Hospital Quality Foundation, or Educational Review Systems, Inc. Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc. accept no liability for the content referenced in this activity.
 
Privacy policy
Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc. are committed to protecting the privacy of those who participate in the activities (herein referred to as "website") located at www.paradigmmc.com. The information below describes the security of the website for safeguarding personal information and the rationale for collection and use of personal information.
 
Security/safeguarding personal information
This website has physical and procedural safeguards in place to prevent unauthorized access to personal information used to access this website.
 
Collection and use of your personal information
The submission of certain personally identifiable information is necessary to award and track the credits participants may earn after completing the program. Required items include first name, last name, degree, and email address. These items are necessary. Participants are also required to complete an evaluation of the CME/CPE activity. All evaluative information submitted is collected and retained, and used by Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc to continuously improve the learning experience.
 
Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc. do not transfer, sell, or share personal information with outside parties. Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc. will not otherwise disclose personal information unless required to in a legal process. Paradigm Medical Communications, LLC, Hospital Quality Foundation, and Educational Review Systems, Inc. staff members review individual test results to the extent necessary to record and track participants’ credits.
 
Contact Us
If you have any questions or comments, please email us at contactus@paradigmmc.com.
 
© 2016 Paradigm Medical Communications, LLC, except where noted. Content may not be reproduced in whole or part without the express written permission of Paradigm Medical Communications, LLC.