Target Audience
This activity has been designed to meet the educational needs of surgeons, hematologists, anesthesiologists, trauma care specialists, and registered nurses involved in the management of patients who may develop acquired factor VIII autoantibodies as a surgical complication.



Statement of Need
Acquired hemophilia A, the spontaneous occurrence of autoantibodies directed against clotting factor VIII, is a rare bleeding disorder, with no apparent cause in nearly half of all diagnosed cases. However, experts in blood disorders agree that two precipitating causes of the spontaneously arising inhibitors may be surgery and older age. This learning activity explores the challenges presented by acquired hemophilia A in the perioperative setting and examines treatment strategies, with a focus on elderly patients.



Purpose/Goal Statement
The purpose of this activity is to provide updated information on how to manage patients with acquired inhibitors to factor VIII.


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

• Describe treatment strategies to manage acute bleeding and inhibitor eradication in patients with autoantibodies against factor VIII
• Explain methods to differentiate an acquired coagulation disorder from a surgically acquired coagulopathy
• Outline ways to balance risk for thrombosis against risk for bleeding in elderly patients with acquired factor VIII inhibitors

Distinguished Faculty
Aryeh Shander, MD, FCCM, FCCP
Chief, 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
New York, New York


Physician Continuing 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 (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM), the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. PIM is accredited by the ACCME to provide continuing medical education for physicians.


Credit Designation
Postgraduate Institute for Medicine designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Nursing Continuing Education
Accreditation Statements
CNA/ANCC
This educational activity for .6 contact hour is provided by Postgraduate Institute for Medicine (PIM).

PIM is an approved provider of continuing nursing education by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.


Method of Participation
During the period May 12, 2009 through May 12, 2010, 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

A statement of credit will be issued upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.


Fee
There is no fee to participate in or to receive credit for this educational activity.


Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and 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 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

Aryeh Shander, MD, FCCM, FCCP

Consulting: Bayer Pharmaceuticals Corporation, Luitpold Pharmaceuticals, Inc., Masimo Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Pharmaceuticals, Ortho Biotech Products, L.P., ZymoGenetics, Inc. Fees for Non-CME Services Received Directly From a Commercial Interest or Their Agents: Bayer Pharmaceuticals Corporation, Masimo Corporation, Novartis Pharmaceuticals Corporation, Ortho Biotech Products, L.P., ZymoGenetics, Inc. Contracted Research: Bayer Pharmaceuticals Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Pharmaceuticals, Ortho Biotech Products, L.P., Pfizer Inc., ZymoGenetics, Inc.

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: Trace Hutchison, PharmD; Jan Hixon, RN, BSN, MA; Linda Graham, RN, BSN, BA; Jan Schultz, RN, MSN, CCMEP; and Julia Kirkwood, RN, BSN	Have no real or apparent conflicts of interest to report.
ECM: Trisha Sullivan, Director; Gay Boyle, 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, and Novo Nordisk Pharmaceuticals 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, Educational Concepts in Medicine, and Novo Nordisk Pharmaceuticals. 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 Novo Nordisk Pharmaceuticals.