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Perioperative Bridging of Anticoagulant Therapy

Learning Objectives
1. Determine whether perioperative interruption of anticoagulation is necessary
2. Chart the appropriate timing of preoperative cessation and postoperative resumption of anticoagulants
3. Identify the indications for bridging anticoagulation in three clinical situations
A. Patients with atrial fibrillation
B. Patients with mechanical heart valves
C. Patients with a history of venous thromboembolism
2 Credits CME

Anticoagulant medications are commonly prescribed to patients in the United States for a number of medical problems. Interruptions in anticoagulation can result in severe adverse outcomes, including permanent disability and death, from arterial and venous thromboembolism. These medications, however, can also be associated with serious perioperative bleeding events. In fact, both bleeding and thromboembolic risks are amplified in the periprocedural period. This module addresses the risk of thromboembolism associated with periprocedural interruption of anticoagulation in patients with atrial fibrillation, a mechanical heart valve, or a history of venous thromboembolism. It is important for hospitalists, who are routinely asked to manage medically complex surgical patients, to understand the periprocedural management of anticoagulation. This module will guide the participant on the perioperative timing of anticoagulant interruption and on the potential need for perioperative bridging anticoagulation.

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Activity Information

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.

Credit Statement Designation: The Society of Hospital Medicine designates this activity for a maximum of 2.00 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Statement: Authors: Dr. Slawski reports having no relevant financial or advisory relationships with corporate organizations related to this activity. Dr. Shiffermiller reports having no relevant financial or advisory relationships with corporate organizations related to this activity. Editors (Leonard Feldman MD, FACP, SFHM and Kurt Pfeifer MD, FACP, SFHM) Dr. Feldman reports having no relevant financial or advisory relationships with corporate organizations related to this activity. Dr. Pfeifer reports having no relevant financial or advisory relationships with corporate organizations related to this activity. Additional planners and faculty for this activity have no relevant relationships to disclose.

SHM COI 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 resolves 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.

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