Reversal and Reinitiation of Anticoagulation

Anticoagulation therapy is associated with increased risk of bleeding, including intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding, which occurs in up to 7% per patient years with an estimated overall mortality rate of 9%.¹ Additionally, urgent surgery with increased bleeding complications in patients on oral anticoagulation appears to be common but has not been well studied.² In this activity, we review strategies to manage potentially life-threatening ICH and GI bleeding and minimize the risk of bleeding with urgent surgery in patients on oral anticoagulation.

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Availability

On-Demand

Expires on Jul 30, 2027

Cost

Member: $0.00

Non-Member: $95.00

Credit Offered

2 CME Credits

2 ABIM-MOC Points

2 Participation Credits

Overview
Faculty
Accreditation
Recommended

Learning Objectives
After completing this activity, learners should be able to:

Recognize the mechanisms of action of available agents for reversal of anticoagulant effects of warfarin and direct-acting oral anticoagulants (DOACs).
Summarize pertinent clinical studies comparing agents for reversal of anticoagulant effect.
Understand strategies for rapid reversal of anticoagulation in ICH, GI bleeding, and before urgent surgery.
Assess the risk of rebleeding after ICH and GI bleeding.
Determine timing of anticoagulation resumption after ICH and GI bleeding.

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.

Faculty

Mehraneh Khalighi
Becca Engels, MD
Scott Kaatz, DO, MSc, SFHM
- Dr. Kaatz reports working as a consultant for Bayer Pharmaceuticals, Inari, Anthos, AstraZeneca, and Gilead Sciences, Inc.
Lily Ackermann, ScM, MD, FACS, SFHM
Kurt Pfeifer, MD, FACP, SFHM, DFPM
Leonard Feldman, MD, FACP, FAAP, MHM

Faculty Disclosures
The faculty and planners of these activities have no relevant relationships to disclose. 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 Credit Statement
The Society of Hospital Medicine designates this online activity for a maximum of 2.00 AMA PRA Category 1 Credit^TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

MOC Credit Statement
Successful 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.

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