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AMDA Long Term Care Medicine - 2014


211 - Antithrombotic Prophylaxis and Treatment in Long-Term Care: Current Best Practice


Feb 28, 2014 1:30pm ‐ Feb 28, 2014 3:00pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this Internet Enduring Material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of clinical 1.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
Disorders which require antithrombotic and antiplatelet therapies are prevalent in long-term care. These therapies are complicated by the proliferation of new agents and an evolving evidence base. In addition, the ubiquity and potential hazards of anti-thrombotic therapies render them a suitable topic for quality improvement initiatives. Accordingly, this session updates current best practices in anticoagulant and antiplatelet therapy and reviews the use, miss-use, and pitfalls of newer agents. A case-based approach will be used first to briefly review current guidelines for antithrombotic management of atrial fibrillation, Cerebro Vascular Accident/Transient Ischemic Attack (CVA/TIA), and venous thromboembolism, post op Deep Vein Thrombosis (DVT) prophylaxis for orthopedic procedures, and antiplatelet therapy post coronary stenting. This overview will serve as a segue to discussion of anticoagulant/antiplatelet management. Topics to be addressed include pharmacokinetic and dosing differences of the new and older agents, significant drug interaction potential, contraindications, monitoring guidelines, antidotes for excessive bleeding, costs, perioperative guidelines, and genotyping recommendations. Presenters will reference appropriate AMDA guidelines and tools. The session will conclude with synthesis of the quality improvement literature concerning antithrombotic/antiplatelet management, and identification of tools and resources for the interdisciplinary team.

Learning Objective(s):

  • Summarize best practices concerning anticoagulant and antiplatelet therapies.
  • Update prescribing considerations for newer agents.
  • Discuss quality improvement opportunities concerning antithrombosis therapies.

Speaker(s):
Daniel Bluestein, MD, MS, CMD; Thomas R. Grant, MD; Thomas Lynch, PharmD

Disclosure(s):
None

Reference(s):
Anderson JL, Halperin JL, Albert NM, Bozkurt B, et al Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 May 7; 61(18):1935-44. Baron TH, Kamath PS, and McBane RD. Management of Antithrombotic Therapy in Patients Undergoing Invasive Procedures. N Engl J Med 2013;368:2113-24 Bluestein D, Brantley C, Barnes-Eley M, Gravenstein S, Basta S. Measuring international normalized ratios in long-term care: a comparison of commercial laboratory and point-of-care device results. J Am Med Dir Assoc. 2007; 8(6):404-8. Dharmarajan TS, Gupta A, Baig MA, Norkus EP. Warfarin: implementing its safe use in hospitalized patients from nursing homes and community through a performance improvement initiative. JAMDA 2011; 12(7):518-23. Dharmarajan TS, Nanda A, Agarwal B, Agnihotri P, Doxsie GL, Gokula M, Javaheri A, Et Al. Prevention of venous thromboembolism in long term care: results of a multicenter educational intervention using clinical practice guidelines: part 2 of 2 (an AMDA Foundation project). JAMDA 2012; 13(3):303-7. Dharmarajan TS, Nanda A, Agarwal B, Agnihotri P, Doxsie GL, Gokula M, Javaheri A, Et Al. Prevention of venous thromboembolism: practice patterns in 17 geographically diverse long term care facilities in the United States: part 1 of 2 (an AMDA Foundation project). JAMDA 2012; 13(3):298-302. Dharmarajan TS, Norkus EP. Venous Thromboembolism Prophylaxis in the Nursing Home: To Do or Not To Do? JAMDA 2013; 14(6):[Epub ahead of print]. Rich MW. Atrial Fibrillation in Long Term Care. JAMDA 2012; 13(8):688-691 Formiga F, Ferrer A, Mimbrera D, Badia T, Fernández C, Pujol R; Grupo de Estudio Octabaix. High rate of anticoagulation therapy in oldest old subjects with atrial fibrillation: the Octabaix study. JAMDA 2012;1 3(1):8-10. Lynch T, Price A. The Effect of Cytochrome P450 Metabolism on Drug Response, Interactions, and Adverse Effects. Am Fam Physician. 2007; 76(3):391-6. Packard KA, Campbell JA, Knezevich JT, and Davis EN. Emerging Antiplatelet Therapy for Coronary Artery Disease and Acute Coronary Syndrome. Pharmacotherapy 2012;32(3):244–273. Weitz JI, Eikelboom JW, and Samama MM. New Antithrombotic Drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141;e120S-e151S.

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