Target Audience
This activity has been designed to meet the educational needs of surgeons, anesthesiologists, hospitalists, registered nurses and their support teams who manage perioperative and postoperative patients at risk for acquired coagulopathy.

Statement of Need\Program Overview
Bleeding among patients undergoing a surgical procedure who may present with already established coagulopathy can lead to poor clinical outcomes. In addition, several surgical procedures can be associated with coagulation disturbances. Uncontrolled perioperative bleeding must be treated aggressively, and often the need for blood transfusion is associated with increased cost, morbidity, and mortality. For treating clinicians, an accurate assessment of bleeding risk is crucial to prevent life-threatening blood loss. This initiative is designed to educate healthcare providers to enable a better understanding and utilization of the concepts of coagulation, available coagulation assays, and the advantages and disadvantages of anticoagulant therapeutic approaches in patients undergoing surgical procedures.

Educational Objectives
After completing this activity, the participant should be better able to:

• Review the prevalence, etiology, pathology, and risk factors of acquired coagulopathy in patients undergoing elective or emergent surgical procedures
• Discuss current concepts of coagulation, including the role played by thrombin generation and fibrinolysis in maintaining hemostasis
• Evaluate the clinical utility of commonly available coagulation assays as well as point-of-care monitoring devices for patients undergoing elective or emergent surgical procedures
• Estimate the clinical impact of bleeding during oral anticoagulant therapy in patients with warfarin-induced excessive anticoagulation
• Assess the clinical effects of newer antithrombotic, anticoagulant, and antiplatelet drugs on perioperative bleeding
• Analyze the advantages and disadvantages of current therapeutic approaches for managing acquired coagulopathy in surgical patients
• Provide appropriate care and counsel for patients and their families

Planning Committee
Bryan A. Cotton, MD, MPH
Associate Professor of Surgery
Department of Surgery and
The Center for Translational Injury Research
The University of Texas Health Science Center at Houston
Houston, Texas

David A. Garcia, MD
Associate Professor
University of New Mexico School of Medicine
Department of Hematology/Oncology
Director, UNM Anticoagulation Management Service
and Ted R. Montoya Hemophilia Treatment Center
UNM Cancer Center
Albuquerque, New Mexico

Maureane Hoffman, MD, PhD
Professor of Pathology and Immunology
Duke University
Director, Blood Bank and Hematology Laboratories
Durham VA Medical Center
Durham, North Carolina

W. Frank Peacock, MD, FACEP
Professor of Emergency Medicine
Cleveland Clinic Foundation
Cleveland, Ohio

Aryeh Shander, MD, FCCM, FCCP
Chief Executive Medical Director
Department of Anesthesiology, Critical Care Medicine,
Pain Management, and Hyperbaric Medicine
Englewood Hospital and Medical Center
Englewood, New Jersey
Clinical Professor of Anesthesiology, Medicine, and Surgery
Mount Sinai School of Medicine
Mount Sinai Hospital
New York, New York

Ira A. Shulman, MD
Professor, Vice Chair of Pathology
Director, Transfusion Medicine Services Group
University of Southern California Keck School of Medicine
Director, Laboratories and Pathology
Los Angeles County and University of Southern California Medical Center
Los Angeles, California

Mark Walsh, MD, FACEP
Clinical Assistant Professor of Medicine
Indiana University School of Medicine—
South Bend at the Notre Dame Campus
Director of Medical Education
Memorial Hospital
South Bend, Indiana

Presenting Faculty
Aryeh Shander, MD, FCCM, FCCP
Chief Executive Medical Director
Department of Anesthesiology, Critical Care Medicine,
Pain Management, and Hyperbaric Medicine
Englewood Hospital and Medical Center
Englewood, New Jersey
Clinical Professor of Anesthesiology, Medicine, and Surgery
Mount Sinai School of Medicine
Mount Sinai Hospital
New York, New York

Physician Continuing Medical Education
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 Postgraduate Institute for Medicine, the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The Postgraduate Institute for Medicine designates this online activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education
Credit Designation
This educational activity for a minimum of 1.0 contact hours is provided by Postgraduate Institute for Medicine.

Accreditation Statement
Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Method of Participation
During the period January 27, 2012 through January 27, 2013, participants must:

• Read the learning objectives and faculty disclosures
• Study the educational activity
• Complete the posttest by recording the best answer to each question
• Complete the evaluation form

Fee Information
There is no fee for this educational activity.
A statement of credit will be issued automatically upon successfully completing the post-test with a score of 70% or better and the activity evaluation.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by PIM for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The planning committee and presenting faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter	Reported Financial Relationship
Bryan A. Cotton, MD, MPH	Consulting Fees: CSL Behring
David A. Garcia, MD	Consulting Fees: Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo Co., Ltd.
Maureane Hoffman, MD, PhD	Contracted Research: Momenta Pharmaceuticals, Novo Nordisk Inc.
W. Frank Peacock, MD, FACEP	Consulting Fees: Abbott Laboratories, Alere, Beckman Coulter, Inc., ElectroCore, LLC., The Medicines Company; Fees for Non-CME/CE Services Received Directly From a Commercial Interest or Their Agents: Abbott Laboratories, Alere, EKR Therapeutics, Inc.; Contracted Research: Abbott Laboratories, Alere, Brahms USA, Inc., Corthera, Inc., EKR Therapeutics, Inc., Nanosphere, Inc., The Medicines Company; Ownership Interest: Comprehensive Research Associates, LLC., Emergencies in Medicine, Vital Sensors, Inc.
Aryeh Shander, MD, FCCM, FCCP	Consulting Fees: Bayer Healthcare Pharmaceuticals, Centocor Ortho Biotech, Inc., Covidien, Luitpold Pharmaceuticals, Inc., Masimo Corporation, The Medicines Company, Novartis, Vifor Pharma, Ltd., ZymoGenetics, Inc.; Fees for Non-CME/CE Services Received Directly From a Commercial Interest or Their Agents: Bayer Healthcare Pharmaceuticals, Centocor Ortho Biotech, Inc., Covidien, CSL Behring, Masimo Corporation, Novartis, ZymoGenetics, Inc.; Contracted Research: Bayer Healthcare Pharmaceuticals, Centocor Ortho Biotech, Inc., Novartis, Pfizer Inc., ZymoGenetics, Inc.
Ira A. Shulman, MD	Royalty: American Association of Blood Banks; Consulting Fees: CSL Behring, HemaCare Corporation, Immucor Gamma, Verax Biomedical Inc.; Fees for Non-CME/CE Services Received Directly From a Commercial Interest or Their Agents: Ortho Biotech Oncology Research & Development, Ortho Clinical Diagnostics, Novartis Oncology, ZymoGenetics, Inc./Bristol-Myers Squibb
Mark Walsh, MD, FACEP	Has no real or apparent conflicts of interest to report.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager	Reported Financial Relationship
PIM Clinical Reviewers: Laura Excell, ND, NP, MS, MA, LPC, NCC; Trace Hutchison, PharmD; Samantha Mattiucci, PharmD, CCMEP; Jan Schultz, RN, MSN, CCMEP; and Patricia Staples, MSN, NP-C, CCRN	Have no real or apparent conflicts of interest to report.
ECM: Pat Crowley, MBA, Managing Director; Jodi Andrews, BS, Associate Director, Educational Programs; Cory Lewis, Program Coordinator; Gay Boyle, MA, Manager, Editorial Services	Have no real or apparent conflicts of interest to report.

Media
Internet

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Cardiovascular & Metabolic Health Foundation (CMH), Educational Concepts in Medicine (ECM), and CSL Behring do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, CMH, ECM, and CSL Behring. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Commercial Support
This activity is supported by an educational grant from CSL Behring.