Dlott JS, George RA, Huang X, et al. National assessment of warfarin anticoagulation therapy for stroke prevention in atrial fibrillation. Circulation. 2014;129:1407-1414. Abstract
Garcia D. Novel anticoagulants and the future of anticoagulation. Thromb Res. 2009;123 (Suppl 4):S50-S55. Abstract
Jacobson AK. In: Ansell JE, Oertel LB, Wittkowsky AK, eds. Managing Oral Anticoagulation Therapy. 2nd ed. St. Louis, Mo: Facts and Comparisons; 2003;45:1-6.
Campbell PM, Radensky PW, Denham CR. Economic analysis of systematic anticoagulation management vs. routine medical care for patients on oral warfarin therapy. Dis Manage Clin Outcomes. 2000;2:1-8.
Ansell JE. In: Ansell JE, Oertel LB, Wittkowsky AK, eds. Managing Oral Anticoagulation Therapy. 2nd ed. St. Louis, Mo: Facts and Comparisons; 2003;44:1-6.
Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med. 1994;120:897-902. Abstract
Hylek EM, Skates SJ, Sheehan MA, Singer DE. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med. 1996;335:540-546. Abstract
Wan Y, Heneghan C, Perera R, et al. Anticoagulation control and prediction of adverse events in patients with atrial fibrillation: a systematic review. Circ Cardiovasc Qual Outcomes. 2008;1:84-91. Abstract
Garcia-Alamino JM, Ward AM, Alonso-Coello P, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev. 2010;4:CD003839.
Bloomfield HE, Krause A, Greer N, et al. Meta-analysis: effect of patient self-testing and self-management of long-term anticoagulation on major clinical outcomes. Ann Intern Med. 2011;154:472-482. Abstract
Heneghan C, Ward A, Perera R et al; Self-Monitoring Trialist Collaboration. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet. 2012;379:322-334. Abstract
DeSantis G, Hogan-Schlientz J, et al. STABLE results: warfarin home monitoring achieves excellent INR control. Am J Manag Care. 2014;20:202-209. Abstract
Matchar DB, Jacobson A, Dolor R, et al; THINRS Executive Committee and Site Investigators. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363:1608-1620. Abstract
Holbrook A, Schulman S, Witt DM, et al; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e152S-e184S.
Triller DM, Wymer S, Meek PD, et al. Trends in Warfarin Monitoring Practices Among New York Medicare Beneficiaries, 2006-2011. J Community Health. 2015;40:845-854. Abstract
Matchar DB, Jacobson AK, Edson RG, et al. The impact of patient self-testing of prothrombin time for managing anticoagulation: rationale and design of VA Cooperative Study #481--the Home INR Study (THINRS). J Thromb Thrombolysis. 2005;19:163-172. Abstract
Dolor RJ, Ruybalid RL, Uyeda L, et al; THINRS Site Investigators. An evaluation of patient self-testing competency of prothrombin time for managing anticoagulation: pre-randomization results of VA Cooperative Study #481--The Home INR Study (THINRS). J Thromb Thrombolysis. 2010;30:263-275. Abstract
Wittkowsky AK, Sekreta CM, Nutescu EA, Ansell J. Barriers to patient self-testing of prothrombin time: national survey of anticoagulation practitioners. Pharmacotherapy. 2005;25:265-269. Abstract
Ansell J, Hirsh J, Hylek E, et al; American College of Chest Physicians. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:160S-198S. Abstract

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Moderator

Jack E. Ansell, MD

Professor of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York

Disclosures

Disclosure: Jack E. Ansell, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Alere; Roche
Served as a speaker or a member of a speakers bureau for: Roche

Dr. Ansell does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Ansell does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelists

Michael B. Streiff, MD

Associate Professor of Medicine and Pathology; Medical Director, Anticoagulation Management Service and Outpatient Clinics, Johns Hopkins Medicine, Baltimore, Maryland

Disclosures

Participation by Dr. Streiff does not constitute or imply endorsement by the Johns Hopkins University or the Johns Hopkins Hospital and Health System.

Disclosure: Michael B. Streiff, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: BiO2 Medical Inc.; CSL Behring; Janssen Pharmaceuticals; Merck & Co., Inc.
Received grants for clinical research from: Janssen Pharmaceuticals; Portola Pharmaceuticals, Inc.

Dr. Streiff does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Streiff does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Daniel M. Witt, PharmD

Professor and Vice Chair, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah

Disclosures

Disclosure: Daniel M. Witt, PharmD, has disclosed no relevant financial relationships.

Dr. Witt does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Witt does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Lynn B. Oertel, MS, ANP-BC, CACP

Nursing Practice Specialist, Massachusetts General Hospital, Boston, Massachusetts

Disclosures

Disclosure: Lynn B. Oertel, MS, ANP-BC, CACP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Roche

Ms. Oertel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Ms. Oertel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Joy P. Marko, MS, APN-C, CCMEP, has disclosed no relevant financial relationships.

Kalanethee Paul-Pletzer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Kalanethee Paul-Pletzer, PhD, has disclosed no relevant financial relationships.

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

CME / CE

Improving Quality of Anticoagulation Management Using Point-of-Care Testing

Authors: Jack E. Ansell, MD; Michael B. Streiff, MD; Daniel M. Witt, PharmD; Lynn B. Oertel, MS, ANP-BC, CACP
CME / CE Released: 5/20/2016; Reviewed and Renewed: 6/21/2017
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 6/21/2018, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians, cardiologists, pharmacists, and nurses.

The goal of this activity is to improve awareness of point-of-care (POC) testing for oral anticoagulation management.

Upon completion of this activity, participants will be able to:

Evaluate the relationship between time in therapeutic range and outcomes for patients on chronic warfarin therapy
Assess the effect of POC international normalized ratio (INR) monitoring and home testing on outcomes for patients receiving warfarin therapy
Identify practical strategies to increase the use of POC for patients on chronic warfarin therapy

Disclosures

Moderator

Jack E. Ansell, MD

Professor of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York

Disclosures

Disclosure: Jack E. Ansell, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Alere; Roche
Served as a speaker or a member of a speakers bureau for: Roche

Dr. Ansell does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Ansell does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelists

Michael B. Streiff, MD

Associate Professor of Medicine and Pathology; Medical Director, Anticoagulation Management Service and Outpatient Clinics, Johns Hopkins Medicine, Baltimore, Maryland

Disclosures

Participation by Dr. Streiff does not constitute or imply endorsement by the Johns Hopkins University or the Johns Hopkins Hospital and Health System.

Disclosure: Michael B. Streiff, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: BiO2 Medical Inc.; CSL Behring; Janssen Pharmaceuticals; Merck & Co., Inc.
Received grants for clinical research from: Janssen Pharmaceuticals; Portola Pharmaceuticals, Inc.

Dr. Streiff does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Streiff does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Daniel M. Witt, PharmD

Professor and Vice Chair, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah

Disclosures

Disclosure: Daniel M. Witt, PharmD, has disclosed no relevant financial relationships.

Dr. Witt does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr. Witt does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Lynn B. Oertel, MS, ANP-BC, CACP

Nursing Practice Specialist, Massachusetts General Hospital, Boston, Massachusetts

Disclosures

Disclosure: Lynn B. Oertel, MS, ANP-BC, CACP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Roche

Ms. Oertel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Ms. Oertel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Joy P. Marko, MS, APN-C, CCMEP, has disclosed no relevant financial relationships.

Kalanethee Paul-Pletzer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Kalanethee Paul-Pletzer, PhD, has disclosed no relevant financial relationships.

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

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Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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Awarded 0.50 contact hour(s) of continuing nursing education for RNs and APNs; 0.50 contact hours are in the area of pharmacology.

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Medscape, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Medscape designates this continuing education activity for 0.50 contact hour(s) (0.050 CEUs) (Universal Activity Number: 0461-0000-16-100-H01-P).

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

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From Medscape Education Cardiology

CME / CE

Improving Quality of Anticoagulation Management Using Point-of-Care Testing

Authors: Jack E. Ansell, MD; Michael B. Streiff, MD; Daniel M. Witt, PharmD; Lynn B. Oertel, MS, ANP-BC, CACPFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 5/20/2016; Reviewed and Renewed: 6/21/2017

Valid for credit through: 6/21/2018, 11:59 PM EST

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Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Moderator

Jack E. Ansell, MD

Panelists

Michael B. Streiff, MD

Daniel M. Witt, PharmD

Lynn B. Oertel, MS, ANP-BC, CACP

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

Kalanethee Paul-Pletzer, PhD

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

CME / CE

Improving Quality of Anticoagulation Management Using Point-of-Care Testing

Target Audience and Goal Statement

Disclosures

Moderator

Jack E. Ansell, MD

Panelists

Michael B. Streiff, MD

Daniel M. Witt, PharmD

Lynn B. Oertel, MS, ANP-BC, CACP

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

Kalanethee Paul-Pletzer, PhD

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Accreditation Statements

For Physicians

For Nurses

For Pharmacists

Instructions for Participation and Credit

Improving Quality of Anticoagulation Management Using Point-of-Care Testing