Anticoagulation Reversal for Life-threatening Bleeding: A Case-based Presentation for the Critical Care Team

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Direct oral anticoagulants (DOACs) are lifesaving drugs for many patients, with transformative impact for patients with atrial fibrillation (AF) and thromboembolism, but they are not without risks. Anticoagulant adverse events have presented hurdles for both healthcare providers and patients, with bleeding complications at the forefront. Although bleeding with anticoagulants is rare, it can result in serious complications necessitating effective reversal strategies. As the treatment landscape of anticoagulant reversal evolves with new approvals, it is essential that the critical care team managing patients on anticoagulation therapy have an in-depth understanding of anticoagulation reversal agents for treatment and management of bleeding. Participants of this activity will gain understanding of DOACs, the risk of bleeding with DOACs, the differences and similarities of available novel reversal agents, and most importantly, practical strategies for implementing these agents into the critical care setting.

Provided by the Society of Critical Care Medicine and Creative Educational Concepts. 
This activity is supported in part by an independent education grant from Portola.

Target Audience

This activity is designed to meet the educational needs of physicians, physician assistants, nurses, pharmacists, and other healthcare professionals.

Learning Objectives

Upon completion of this activity, participants should be better able to:  

  • Appraise the risk of bleeding with DOAC therapy, describe the risk factors associated with bleeding, and examine the strategies to mitigate these risks in order to improve patient and healthcare system outcomes.
  • Differentiate between available and emerging novel, specific anticoagulation reversal agents; assessing their differences and similarities in mechanism of action; and review the latest clinical trial data and practical administration considerations.
  • Evaluate the role of the critical care team in developing a protocol for implementation of novel anticoagulation reversal agents and design treatment strategies for patients with bleeding complications
Course summary
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Gregory Piazza, MD
Assistant Professor of Medicine
Harvard Medical School
Associate Physician
Brigham and Women's Hospital
Cardiovascular Medicine
Boston, Massachusetts

John Fanikos, MBA, RPh
Assistant Professor of Clinical Pharmacy Practice
Northeastern University
Massachusetts College of Pharmacy
Director of Pharmacy Business and Financial Services
Brigham and Women’s Hospital
Boston, Massachusetts

Jorge Antonio Gutierrez, MD
Assistant Professor of Medicine
Department of Medicine; Division of Cardiology
Duke University
Durham, North Carolina

All faculty participating in continuing medical education (CME) programs must disclose to the learners any financial interests with any commercial supporter or other relationships with manufacturers or providers of any product or service related to the content of their presentations. All content is peer reviewed to ensure its quality and independence. The following financial relationships are disclosed: 

Susan H. Gitzinger, PharmD, MPA–No financial relationships
Vanessa Carranza, PharmD–No financial relationships
Diane Alberson, MEd–No financial relationships 
Audra Kubilius, CAE–No financial relationships 

John Fanikos, MBA, RPh—has no relevant financial relationships to disclose in relation to the content of this activity. 
Jorge Antonio Gutierrez, MD—has no relevant financial relationships to disclose in relation to the content of this activity. 
Gregory Piazza, MD—has disclosed that he is a consultant for Pfizer, Portola, and Thrombolex. He also receives grant/research support from Bristol-Myers Squibb, BTG/EKOS, Daiichi-Sankyo, and Janssen. 

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Society of Critical Care Medicine and Creative Educational Concepts. The Society of Critical Care Medicine (SCCM) is accredited by the ACCME to provide continuing medical education for physicians.

The Society of Critical Care Medicine designates this live educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Society of Critical Care Medicine (SCCM) is approved by the California Board of Registered Nursing, Provider No. 8181, for 1.5 contact hours. This activity is designated for 1.5 contact hours.

The Society of Critical Care Medicine (SCCM) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This application-based activity is approved for 1.5 contact hours (.15 CEUs) of continuing pharmacy education credit (0236-9999-20-203-H01-P).

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