CME

Managing Venous Thromboembolism (VTE) in Hospitalized Patients: Considerations for the Use of Novel Oral Anticoagulants (NOACs)

 

SUPPORT
This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc. and Daiichi Sankyo, Inc.

ACCREDITATION

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 Penn State College of Medicine and PlatformQ. Penn State College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Penn State College of Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Penn State College of Medicine designates this enduring activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DATE OF ORIGINAL RELEASE/EXPIRATION
Released September 22, 2014. Expires March 22, 2015

ESTIMATED TIME TO COMPLETE ACTIVITY
60 minutes per session for a possible total of 1 hour.

ACTIVITY DESCRIPTION

Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), affect an estimated 300,000 to 6000,000 patients each year in the United States. Although regarded as "the most common preventable cause of hospital death", as many as 100,000 adults die from VTE each year. Patients who develop VTE are not only at a substantial risk for increased mortality, but also are at risk for recurrent VTE, post-thrombotic syndrome, and chronic pulmonary hypertension. Following a first episode of DVT, 20% of patients suffer a recurrent thromboembolic event and up to 50% develop post-thrombotic syndrome (PTS) within 2 years. Frequently, these conditions are associated with suboptimal treatment of the initial VTE event and inadequate secondary prophylaxis.

Several major organizations have published guidelines on the treatment of VTE and prevention of recurrent VTE. While limitations of currently recommended treatment strategies are one barrier to optimal outcomes in VTE treatment, evidence suggests that physician attitudes and knowledge also influence treatment. For example, one survey found that only 54% of physicians followed evidence-based clinical guidelines for the management of VTE; 46% reported choosing therapy on a case-by-case basis. Assessment of risk for VTE recurrence also poses ongoing clinical challenges. Although efforts to create risk assessment tools have been attempted to predict an initial VTE event, none of these models have been validated for use in evaluating risk of VTE recurrence. Thus, clinicians must rely on qualitatively weighing multiple patient factors, risks and benefits of anticoagulation therapies, and clinical judgment to guide treatment decisions for secondary prophylaxis. Finally, studies investigating real-world treatment patterns have found that in addition to many patients only receiving a short duration of treatment with standard anticoagulants, patient medication adherence is also a limiting factor in treatment outcomes. Poor compliance and persistence to long-term anticoagulant therapy is associated with an increased risk of recurrence.

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

Evaluate the use of novel oral anticoagulants to treat hospitalized patients with VTE
Assess patients for risk of VTE recurrence
Select and initiate an appropriate prophylaxis strategy for patients at risk for VTE recurrence
Discuss strategies for overcoming adherence to prophylactic regimens in patients at risk for VTE recurrence

TARGET AUDIENCE
Hospitalists, emergency medicine, pulmonologists, internists, hematologists and other healthcare professionals who care for patients with venous thromboembolism.

FORMAT
Internet

METHOD OF PARTICIPATION
There are no fees for participating and receiving CME credit for this activity. During the period of September 22, 2014 through March 22, 2015, participants must:

1. Read the educational objectives and faculty disclosures
2. Listen to the materials and study the educational activity
3. Complete and submit the online post-test and the evaluation form

HARDWARE & SOFTWARE REQUIREMENTS
Participants will need a computer with a recent version of Adobe Flash installed, as well as an internet connection sufficient for streaming media.

DISCLOSURE INFORMATION

FACULTY NAME AND LECTURE TITLE(S): RELATIONSHIP(S):
Samuel Z. Goldhaber, MD
Research Grants: Bristol-Myers Squibb, Daiichi Sankyo, BTG, National Heart, Lung, and Blood Institute, Thrombosis Research Institute (London, UK)
Consultant: Ariad, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Genentech, Janssen, Merck, Pfizer, Portola
Christian T. Ruff, MD, MPH
Consultant: Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo

PlatformQ and Penn State College of Medicine staff and faculty and involved in the development and review of this activity have disclosed no relevant financial relationships.

ACTIVITY DIRECTOR
Samuel Z. Goldhaber, MD
Professor of Medicine
Harvard Medical School

CONTACT INFORMATION
Information about CME credit for this activity is available by contacting Penn State at 717-531-6483 or ContinuingEd@hmc.psu.edu. Reference course #G5616-15-V for the live activity and G5617-15-T for the enduring activity.

DISCLAIMERS (if applicable):

The material is prepared based on a review of multiple sources of information but is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials about the subject matter other than relying solely on the information contained in this material.

The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, Penn State College of Medicine, CardioCareLive, PlatformQ Health or the program grantor. Reasonable efforts have been made to present educational subject matter in a balanced, unbiased fashion and in compliance with regulatory requirements. Each participant must use his/her 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.

 

Selecting Oral Antiplatelet Regimens for Patients with STEMI

 

SUPPORT
This activity is supported by an educational grant from Daiichi Sankyo, Inc and Lilly USA, LLC.

ACCREDITATION

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 Penn State College of Medicine and PlatformQ. Penn State College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Penn State College of Medicine designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Penn State College of Medicine designates this enduring activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DATE OF ORIGINAL RELEASE/EXPIRATION
Released September 24, 2014. Expires November March 24, 2015.

ESTIMATED TIME TO COMPLETE ACTIVITY
60 minutes per session for a possible total of 1 hour.

ACTIVITY DESCRIPTION

Myocardial infarction is the most serious form of acute coronary syndrome (ACS). In the United States, myocardial infarction (MI) occurs in 4.2% of adult men and 1.7% of adult women, representing an MI occurring every 44 seconds. Approximately 635,000 Americans will experience a new MI this year, while around 280,000 will have a recurrent MI. There are between 125,000 to 160,000 deaths each year from MI.

Of the two forms of MI, the ST segment elevation MI (STEMI) represents more severe ischemia and the presence of ongoing transmural myocardial injury compared to non-ST-segment elevation MI (NSTEMI). STEMI requires reperfusion therapy, either angioplasty (percutaneous coronary intervention; PCI) or medically treated thrombolysis with antiplatelet therapy. Based on US and European registries, the rate of STEMI among all MI patients ranges from 29% to 47%. An estimated 492,000 patients underwent PCI in the United States. Increasing use of PCI has been associated with reductions in mortality due to MI.

Time to treatment is a critical factor determining mortality risk as well as preferred method of reperfusion therapy. Latest guidelines from ACC Foundation/AHA for management of STEMI highlight the importance of triage at first medical contact (FMC) to expedite appropriate patients to receive PCI treatment within the goal time period (90 minutes within system; 120 minutes for patient transfer for PCI). The guidelines also include the use of newer P2Y12 inhibitors, (prasugrel and ticagrelor). These or clopidogrel should be initiated as early as possible or at the time of primary PCI. According to guidelines, duration of dual antiplatelet therapy (DAPT) after PCI ranges from 1 month post for bare-metal stent (BMS) procedures to 6 months to 12 months for drug-eluting stent (DES) procedures. However, the optimal duration of DAPT continues to challenge clinicians as the latest research shows that type of stent may not be the best predictor for risk of ischemic event but rather the specific device and patient characteristics may be more influential on risk. l
EDUCATIONAL OBJECTIVES
Upon completion of this activity, participants should be better able to:

Review considerations for selection of DAPT in patients undergoing PCI
Outline considerations for duration of DAPT in patients who have undergone PCI
Identify individual patient characteristics that may influence treatment success, such as comorbidities and individual variability in antiplatelet response

TARGET AUDIENCE
Cardiologists, interventionalists, internists, family physicians, nurse practitioners, physician assistants, pharmacists, nurses, and other healthcare professionals who care for patients with STEMI.

FORMAT
Internet

METHOD OF PARTICIPATION
There are no fees for participating and receiving CME credit for this activity. During the period of September 24, 2014 through March 24, 2015, participants must:

1. Read the educational objectives and faculty disclosures
2. Listen to the materials and study the educational activity
3. Complete and submit the online post-test and the evaluation form

HARDWARE & SOFTWARE REQUIREMENTS
Participants will need a computer with a recent version of Adobe Flash installed, as well as an internet connection sufficient for streaming media.

DISCLOSURE INFORMATION

FACULTY NAME AND LECTURE TITLE(S): RELATIONSHIP(S):
Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC
Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company
E. Magnus Ohman, MD, FRCPI, FESC, FACC, FSCAI
Consultant: Abiomed, AstraZeneca, Daiichi Sankyo, Eli Lilly &, Company, Gilead Sciences, Janssen Pharmaceuticals, Pozen, Inc. Sanofi Aventis, The Medicines Company, WebMD
Research Grants: Daiichi Sankyo, Eli Lilly & Company, Gilead Sciences

PlatformQ and Penn State College of Medicine staff and faculty and involved in the development and review of this activity have disclosed no relevant financial relationships.

ACTIVITY DIRECTOR
Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC
Professor of Medicine
Harvard Medical School

CONTACT INFORMATION
Information about CME credit for this activity is available by contacting Penn State at 717-531-6483 or ContinuingEd@hmc.psu.edu. Reference course # G5624-15-V for the live activity and G5625-15-T for the enduring activity.

DISCLAIMERS (if applicable):

The material is prepared based on a review of multiple sources of information but is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials about the subject matter other than relying solely on the information contained in this material.

The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, Penn State College of Medicine, CardioCareLive, PlatformQ Health or the program grantor. Reasonable efforts have been made to present educational subject matter in a balanced, unbiased fashion and in compliance with regulatory requirements. Each participant must use his/her 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.

 
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