Anticoagulation Certificate

   
The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.

This certificate is intended for pharmacists seeking to expand their knowledge and skills in anticoagulation therapy management.

Introduction to Anticoagulation Therapy
ACPE: 0204-0000-26-807-H01-P
Application-based
1.75 contact hours 

Learning Objectives:

• Explain the structure and function of the coagulation cascade including the intrinsic, extrinsic, and common pathways.
• Differentiate key clotting factors and their roles in thrombus formation and propagation.
• Describe how fibrinolysis occurs in the human body and compare the mechanisms of action of thrombolytic agents and their role in fibrinolysis relative to anticoagulants.
• Explain the mechanisms of action of major anticoagulant classes, including heparins, direct oral anticoagulants (DOACs), and vitamin K antagonists.
• Explain fundamental anticoagulation management concepts including, but not limited to, the following:
  • Anticoagulant therapeutic classes;
  • The evolution of anticoagulation therapies, monitoring, and management;
  • Indications for anticoagulation; and
  • The various roles pharmacists play in anticoagulation management.
• Describe the impact of regulatory agencies, accreditation organizations, patient safety and quality organizations, and healthcare payers on anticoagulation care.
• Describe the need for, and functions of, an anticoagulation oversight committee in a hospital or other healthcare organization.
• Explain considerations that an anticoagulation oversight committee should take into account when evaluating and revising an organization’s current anticoagulation-related policies and processes. 

Using Laboratory Assessments to Inform Anticoagulation Management Plans
ACPE: 0204-0000-26-808-H01-P
Application-based
2 contact hours 

Learning Objectives:

• Explain analytical tests utilized in the assessment and management of anticoagulant agents.
• Summarize the limitations of anticoagulant assays.
• Design an anticoagulation plan that incorporates assays to inform management decisions. 

Warfarin
ACPE: 0204-0000-26-809-H01-P
Application-based
5 contact hours 

Learning Objectives:

• Select an appropriate starting dose, INR follow-up plan, and key patient education points for a patient starting warfarin therapy.
• Determine an appropriate dosing/management strategy based on the clinical situation when a patient on warfarin presents to the hospital.
• Determine an appropriate dosing/management strategy based on the clinical situation when a hospitalized patient on warfarin transitions to a different level of care (critical care, sub-acute, home).
• Develop an effective management strategy when a patient experiences a clinically significant drug-drug or dietary interaction.
• Formulate an effective management strategy when presented with an ambulatory patient struggling with warfarin therapy.
• Explain aspects of safe and effective anticoagulation management for ambulatory patients including, but not limited to, the importance of INR time in therapeutic range (TTR), home INR monitoring and self-management, and patient education.
• Modify a patient’s warfarin and direct oral anticoagulant (DOAC) therapy in an outpatient anticoagulation service.
• Summarize how to document care in the management of medications in an outpatient anticoagulation service. 

Direct Oral Anticoagulants
ACPE: 0204-0000-26-810-H01-P
Application-based
2 contact hours 

Learning Objectives:

• Compare appropriate clinical and patient-specific characteristics for direct oral anticoagulant (DOAC) and warfarin therapy.
• Identify potential organ system and drug interactions with direct oral anticoagulants (DOACs).
• Design appropriate management strategies for a patient with organ system and drug interactions with DOACs.
• Develop a plan to successfully convert a patient from warfarin to a direct oral anticoagulant (DOAC). 

Parenteral Anticoagulants and Heparain-Induced Thrombocytopenia
ACPE: 0204-0000-26-811-H01-P
Application-based
3.25 contact hours 

Learning Objectives:

• Identify the differences among unfractionated heparin, low molecular weight heparin (LMWH), and fondaparinux.
• Explain how to initiate and monitor heparin, low molecular weight heparins (LMWHs), and fondaparinux for various indications.
• Recommend dose adjustments of heparin, LMWHs, and fondaparinux based on patient-specific considerations.
• Describe the pathophysiology and approaches to recognize heparin-induced thrombocytopenia (HIT).
• Discuss approaches to managing heparin-induced thrombocytopenia (HIT).
• Discuss how to initiate and manage anticoagulation therapy in HIT.
• Discuss how to initiate and manage parenteral direct thrombin inhibitors. 

Venous Thromboembolism Prophylaxis and Treatment
ACPE: 0204-0000-26-812-H01-P
Application-based
2.5 contact hours 

Learning Objectives:

• Explain the pathophysiology of venous thrombosis using Virchow’s Triad.
• Identify major risk factors associated with venous thrombosis and bleeding in hospitalized patients.
• Apply validated venous thromboembolism and bleeding risk assessment tools to determine appropriate thromboprophylaxis strategies in hospitalized patients.
• Use evidence-based decision-making to select optimal thromboprophylaxis regimens based on individual patient risk profiles.
• Describe how acute venous thromboembolism (VTE) is diagnosed.
• Identify evidence-based anticoagulation options with recommended dosing for initial VTE treatment.
• Design an individualized anticoagulation plan for a patient with an acute VTE including a risk-benefit assessment and determination of duration of anticoagulation therapy. 

Anticoagulation for Atherosclerotic Cardiovascular Disease Indications
ACPE: 0204-0000-26-813-H01-P
Application-based
1.5 contact hours 

Learning Objectives:

• Compare and contrast the key characteristics and treatment considerations for arterial versus venous thromboembolism.
• Design an appropriate antithrombotic treatment regimen for coronary artery disease patients who also have either atrial fibrillation or venous thromboembolism.
• Design an appropriate antithrombotic treatment regimen for peripheral artery disease and cardiovascular disease patients. 

Thrombolytic Therapy
ACPE: 0204-0000-26-814-H01-P
Application-based
2.5 contact hours 

Learning Objectives:

• Explain the pharmacology, pharmacokinetics, and pharmacodynamics of the commonly used thrombolytics.
• Compare the contraindications to thrombolytic therapy in patients with acute ischemic stroke, pulmonary embolism, and myocardial infarction.
• Assess a patient’s potential benefits and risks, including contraindications, associated with thrombolytic therapy.
• Design an appropriate thrombolytic treatment plan for a patient with a life- or limb-threatening thrombosis.
• Design a subsequent antithrombotic treatment plan for a patient with a life- or limb threatening thrombosis. 

Anticoagulation to Decrease Stroke Risk in Patients with Atrial Fibrillation
ACPE: 0204-0000-26-815-H01-P
Application-based
1 contact hour 

Learning Objectives:

• Categorize an atrial fibrillation patient’s risk of stroke and bleeding in order to make treatment decisions.
• Develop an individualized anticoagulation plan for a patient with atrial fibrillation.
• Describe anticoagulation considerations related to ablations and anticoagulation alternatives in atrial fibrillation. 

Anticoagulation Management in Acutely Ill Patients
ACPE: 0204-0000-26-816-H01-P
Application-based
1.75 contact hours 

Learning Objectives:

• Explain challenges that can occur with anticoagulants in acutely and critically ill patients.
• Describe characteristics of effective anticoagulation management specific to acutely ill patients.
• Summarize what pharmacists need to consider in adapting anticoagulant therapy to acutely ill patients. 

Anticoagulation Management During the Perioperative Period
ACPE: 0204-0000-26-817-H01-P
Application-based
1.75 contact hours 

Learning Objectives:

• Explain the clinical information that must be obtained and considered when developing a perioperative anticoagulation management plan.
• Assess surgical patient's risks of thrombosis and bleeding during the perioperative period based on the type of procedure and patient-specific factors.
• Develop perioperative antithrombotic management plans that include the following:
  • Need for bridge therapy;
  • Factors that impact the duration of decline of anticoagulant and antiplatelet effects;
  • When to begin holding anticoagulants and antiplatelet medications preoperatively; and
  • Reversal options.
• Design perioperative antithrombotic management plans that include considerations applicable to the intra- and postoperative stages of surgical care, as well as following discharge. 

Anticoagulation Reversal
ACPE: 0204-0000-26-818-H01-P
Application-based
1.75 contact hours 

Learning Objectives:

• Describe potential bleeding challenges during anticoagulation therapy.
• Design an anticoagulation agent-specific reversal plan.
• Summarize available anticoagulant medications and ways to reverse their effects.
• Describe the various agents used to reverse anticoagulant effects. 

Anticoagulation in Patients with Mechanical Devices
ACPE: 0204-0000-26-819-H01-P
Application-based
1.25 contact hours 

Learning Objectives:

• Analyze a patient’s device-specific anticoagulation regimen.
• Design a patient- and device-specific anticoagulation regimen. 

Anticoagulation in Special Patient Populations - Part I
ACPE: 0204-0000-26-820-H01-P
Application-based
2.75 contact hours 

Learning Objectives:

• Describe skills required by pharmacists to assess if patients require special management considerations.
• Design monitoring parameters for patients within special populations receiving anticoagulants.
• Describe how factors for patients within special populations can alter risk for bleeding or thrombosis independent of direct effects on the anticoagulation regimen.
• Analyze anticoagulation-related outcomes in patients with renal insufficiency.
• Select appropriate anticoagulant therapy in patients with renal insufficiency.
• Describe how factors associated with the geriatric patient population can alter risks of bleeding and thrombosis independent of direct effects on the anticoagulation regimen.
• Analyze anticoagulation-related outcomes in the geriatric patient population.
• Select appropriate anticoagulant therapy for patients in the geriatric patient population.
• Discuss characteristics in pregnant women that put them at higher risk for venous thromboembolism (VTE).
• Apply key components for managing a pregnant patient with a VTE before, during, and after delivery.
• Apply components and activities for managing a pediatric patient requiring anticoagulation therapy for a venous thromboembolism (VTE). 

Anticoagulation in Special Patient Populations - Part II
ACPE: 0204-0000-26-821-H01-P
Application-based
1.5 contact hours 

Learning Objectives:

• Describe the clinical presentations and testing considerations for hypercoagulable conditions.
• Develop a management plan to mitigate the risk of thrombosis in patients with antiphospholipid syndrome (APS).
• Assess the role of cancer as a hypercoagulable state.
• Apply current evidence when developing a treatment plan for patients with cancer-associated thrombosis.
• Analyze anticoagulation-related outcomes in the obese patient population.
• Select appropriate anticoagulant therapy for patients with obesity. 

Antithrombotic Stewardship
ACPE: 0204-0000-26-822-H01-P
Application-based
0.75 contact hour 

Learning Objectives:

• Describe the core elements of an antithrombotic stewardship program.
• Apply principles of antithrombotic stewardship within your current practice site. 

Skills for Managing Anticoagulation Therapy
ACPE: 0204-0000-26-823-H01-P
Application-based
3 contact hours 

Learning Objectives:

• Describe the skills needed to develop, initiate, assess, and adjust anticoagulation therapy management plans.
• Summarize the pharmacist’s role in managing anticoagulation therapy.
• Apply concepts learned in managing anticoagulation therapy.
• Create a plan for continued self-development to evolve as an anticoagulation therapy provider.

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company. 

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

The following persons in control of this activity’s content have relevant financial relationships:

• Anne Rose: Bristol Myers Squibb (BMS), advisory board. 

All other persons in control of content do not have any relevant financial relationships with an ineligible company. 

As defined by the Standards of Integrity and Independence in Accredited Continuing Education definition of ineligible company. All relevant financial relationships have been mitigated prior to the CE activity.

Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity.

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity.

Important Note – ACPE 60 Day Deadline:

Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP eProfile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity.