Overview
Sponsored by the American College of Chest Physicians.
Supported by an unrestricted educational grant from GlaxoSmithKline.
Program Description
Particularly in the ICU, properties of the much-promoted, new subcutaneous injectable anticoagulants (low-molecular-weight heparins, fondaparinux) are perceived to carry important limitations, eg, long half-lives, and questionable absorption in patients who are being underperfused. Moreover, supposed limitations of unfractionated heparin (need for titration during pulmonaryembolism treatment, risk of heparin-induced thrombocytopenia, etc) may not pose much real risk in settings where patients can be closely monitored. However, newer anticoagulants also are perceived to be more effective for venous thromboembolism (VTE) prophylaxis, an important advantage for the sickest patients. These patients may have impaired hemostasis and other increased comorbid bleeding risks if thrombosis occurs and full anticoagulation becomes necessary. The speakers synthesize available data relating to prophylaxis and treatment of VTE to support their different viewpoints about when newer or older anticoagulants are preferred. There is a special focus on the types of fragile patients in hospitals or clinics that pulmonary and critical physicians are most likely to encounter.
In this web-based format, participants have the opportunity to obtain the information as it was originally presented by watching the video slide presentations on line, downloading the slides for review, or downloading a written executive summary of the presentations to read. Following their review of the presentations, participants will be asked relevant test questions as part of the evaluation process to obtain CME credit.
Educational Objectives
- List one recommendation, as supported by the published evidence, that supports the routine use of anticoagulant therapy for VTE prophylaxis in the hospitalized medical patient.
- Identify limitations and complications of heparin therapy for VTE prophylaxis.
- Rank two different anticoagulants that are available for VTE prophylaxis based on a presented case study.
Target Audience
Advanced practice nurses, cardiologists, critical care physicians, fellows-in-training, general medicine physicians, physician assistants, pulmonary physicians, registered nurses
Needs Assessment
The role of multiple anticoagulants available in clinical practice is not firmly established in the current literature. This session attempts to rationalize the use of the various kinds of heparin and direct thrombin inhibitors available today.
Faculty
Bruce L. Davidson, MD, FCCP
Senior Associate Dean for Clinical Affairs
Professor of Medicine
Weill Cornell Medical College in Qatar
Doha, Qatar
Roger D. Yusen, MD, FCCP
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Washington University School of Medicine
St. Louis, MO
Timothy A. Morris, MD, FCCP
Director, Pulmonary Clinical Programs
UCSD Medical Center
San Diego, CA
CME & Disclaimers
Release: March 2009
CME Expiration: December 31, 2009
Estimated completion time: 2 hours
This CME product is a Web-based activity. Participants will watch and listen to a Webcast slide presentation, and complete an activity evaluation to obtain CME.
Accreditation - Designation
The American College of Chest Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American College of Chest Physicians designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Anyone who attended the Evidence-Based Treatment of Pulmonary Arterial Hypertension in an Evolving Environment session at CHEST 2008 when this content was presented and already claimed CME for this presentation cannot claim CME from this enduring product.
Disclosure Statement
The ACCP remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the ACCP to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the ACCP to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair, the Education Committee, or the Conflict of Interest Review Committee to ensure that such situations are properly evaluated and, if necessary, resolved. The ACCP educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all ACCP CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available on-site during all educational activities.
The following faculty members of this educational activity have disclosed to the ACCP that a relationship does exist with the respective company/organization as it relates to their presentation of material and should be communicated to the participants of this educational activity:
Bruce L. Davidson, MD, FCCP
Consultant fee, speaker bureau, advisory committee, etc: Clinical trial research funding and consulting fees from Bayer, Bristol Myers Squibb, Sanofi, Portola, Boehringer-Ingelheim, GlaxoSmithKline
Product/procedure/technique that is considered research and is NOT yet approved for any purpose: Oral inhibitors of activated factor X and of activated factor II (anticoagulants)
Roger D. Yusen, MD, FCCP
Grant monies (from industry-related sources): Sanofi-Aventis, Bayer
Consultant fee, speaker bureau, advisory committee, etc: Sanofi-Aventis, Novartis, Scios
Product/procedure/technique that is considered research and is NOT yet approved for any purpose: Apixiban, Dabigitran, Rivaroxaban, Biotinolated Idraparinux
The following faculty members of this educational activity have indicated to the ACCP that no potential conflict of interest exists with any respective company/organization:
Timothy A. Morris, MD, FCCP
Consultant fee, speaker bureau, advisory committee, etc: Actelion Pharmaceuticals, CoTherix, Inc. (purchased by Actelion Pharmaceuticals), Myogen, Inc. (purchased by Gilead Sciences), Gilead Sciences
Disclaimer
The American College of Chest Physicians (“ACCP”) and its officers, regents, executive committee members, members, related entities, employees, representatives and other agents (collectively, “ACCP Parties”) are not responsible in any capacity for, do not warrant and expressly disclaim all liability for, any content whatsoever in any ACCP publication or other product (in any medium) and the use or reliance on any such content, all such responsibility being solely that of the authors or the advertisers, as the case may be. By way of example, without limiting the foregoing, this disclaimer of liability applies to the accuracy, completeness, effectiveness, quality, appearance, ideas, or products, as the case may be, of or resulting from any statements, references, articles, positions, claimed diagnosis, claimed possible treatments, services, or advertising, express or implied, contained in any ACCP publication or other product. Furthermore, the content should not be considered medical advice and is not intended to replace consultation with a qualified medical professional. Under no circumstances, including negligence, shall any of the ACCP Parties be liable for any DIRECT, INDIRECT, INCIDENTAL, SPECIAL or CONSEQUENTIAL DAMAGES, or LOST PROFITS that result from any of the foregoing, regardless of legal theory and whether or not claimant was advised of the possibility of such damages.
CME Instructions
CME for this activity is available through December 31, 2009. To receive CME credit and print your certificate, complete an online evaluation:
- Go to www.chestnet.org, and click on the “CME Certificates” icon.
- Log in using your ACCP ID number or e-mail address on file with the ACCP. Enter your ACCP ID number, and click submit, OR, if you do not have an ACCP ID number, click on the link “Create an account here.”
- To locate the product for which you want to claim CME credit, look under the “Available CME” tab on the left navigation bar.
- Click the “Claim Credit” link next to the product to begin the certificate process.
- Complete any required posttest and evaluation. Please be sure to check the box that states you are finished with the evaluation.
- Once you submit the evaluation, your CME certificate will be created and will show under the tab, “My CME History.” You can print it at any time by clicking the “Certificate” link.
If you need help, please contact the CME Administrator via e-mail at CME@chestnet.org, or leave a voice mail message at (847) 498-8376. For faster assistance, please outline the specific problem you are having, and provide your ACCP ID and contact information.
Related Materials
Download a Written Summary (pdf)
Download the Presentation Slides (pdf)
Pneumatic Compression for Venous Thromboembolism Prophylaxis: 2008 Update
Bruce L. Davidson, MD, FCCP
Unfractionated Heparin Is Preferable to Other Heparins for the Most Acutely Ill Hospitalized Patients
Timothy A. Morris, MD, FCCP
Newer Heparins Should by Now Replace Unfractionated Heparin for Prescribing Intensivists and Pulmonologists
Roger D. Yusen, MD, FCCP
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