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Please note that CE credit for this activity has expired. The following activity is presented for reference purposes only.


Anticoagulant medications are commonly prescribed to patients in the United States for a number of medical problems. The risk of adverse outcomes, including permanent disability and death, from arterial and venous thromboembolism is high. Anticoagulant medications used to reduce the risk of thromboembolism can also be associated with serious bleeding outcomes. Physicians who prescribe these medications need to carefully weigh the risk of thromboembolism and potential for bleeding. In the periprocedural period, bleeding and thromboembolic risks are amplified. Careful decisions regarding management of chronic anticoagulation need to be undertaken. It is important for hospitalists, who are routinely asked to manage medically complex surgical patients, to understand periprocedural management of anticoagulation. This module discusses the risk of venous thromboembolism and arterial thromboembolism associated with the interruption of anticoagulation in patients with a history of these events. Risk of arterial thromboembolism in patients with atrial fibrillation and mechanical heart valves in the periprocedural period is also addressed. Preoperative and postoperative management of anticoagulation, accounting for patient and procedural risk factors of thromboembolism and bleeding, are also discussed.


To provide hospitalists with current data and guidelines regarding perioperative management of anticoagulation.


This activity is designed for hospitalists and residents interested in the field of consultative medicine. No prerequisites required.


After completing the module, the participant should be able to:
  1. Determine the appropriate timing for preoperative cessation of anticoagulants, including novel oral agents, and initiation of bridging anticoagulation.
  2. Design a perioperative anticoagulation management plan for patients with venous thromboembolism.
  3. Identify patients with chronic atrial fibrillation who may benefit from perioperative bridging anticoagulation.
  4. Formulate a perioperative anticoagulation management plan for patients with mechanical heart valves.
  5. Determine the appropriate timing for postoperative resumption of anticoagulants, including novel oral agents.


Accreditation Statement:
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 sponsorship of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement:
The University of Virginia School of Medicine designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: December 20, 2013. Expiration date: December 20, 2014.

Estimated time to complete activity: 2 hours


Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.

The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.

All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.

The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.

The following relationships have been reported for faculty of this activity:

Leonard Feldman, MD, FACP, FAAP, SFHM (Chair)
Assistant Professor of Medicine and Pediatrics
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Barbara Slawski, MD, MS, FACP
Associate Professor of Medicine and Orthopedic Surgery
Medical Director, Froedtert Hospital Perioperative Services
Chief, Section of Perioperative and Consultative Medicine, Department of Medicine
Froedtert and Medical College of Wisconsin
Dr Slawski reports serving on the advisory committee/board as a contributing editor to MedReviews, LLC.

George Hoke, MD (Peer Reviewer)
Associate Professor of Clinical Internal Medicine
University of Virginia Health System
Charlottesville, Virginia
Dr. Hoke reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.

All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.


The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the University of Virginia School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Click here to download the references for this educational activity.


The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.

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