Target Audience
This activity has been designed to meet the educational needs of anesthesiologists, surgeons and surgical team members, trauma specialists, hematologists, and other clinicians involved in the restoration of hemostasis in cardiac surgery patients.


Statement of Need
Bleeding associated with cardiac surgery continues to be a major concern for surgeons, anesthesiologists, patients, and their families. Major bleeding and hemorrhage occurs in 5% to 7% of cardiac surgery cases and is a significant predictor of increased morbidity and mortality. Bleeding following cardiac surgery is often multifactorial and may involve inhibition of hemostasis or platelets, tissue or vascular injury, dilutional coagulopathy, and more. In combination with the continued concern for the risk of transmitting transfusion-mediated infections, this has stimulated interest in strategies to reduce perioperative blood loss associated with cardiac surgery. This learning activity provides clinicians with strategies for reversing bleeding and presents a multifactorial approach to managing hemostasis in cardiac surgery patients.


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

• Explain the essential aspects of hemostasis, including the role played by platelets and coagulation factors in clot formation
• Evaluate the clinical utility of coagulation lab assays and key biomarkers for excessive perioperative bleeding
• Discuss current and emerging therapeutic options for restoring perioperative hemostasis in cardiac surgery patients
• Identify frequently encountered complications of cardiac surgery due to bleeding

Distinguished Faculty
Peter K. Smith, MD
Professor and Chief
Division of Cardiovascular and Thoracic Surgery
Duke University Medical Center
Durham, North Carolina


Ian J. Welsby, MD, MBBS, FRCA
Assistant Professor
Department of Anesthesiology and Critical Care
Duke University Medical Center
Durham, North Carolina



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 (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 1.0 AMA PRA Category 1 Credit(s)™. Clinicians should only claim credit commensurate with the extent of their participation in the activity.


Method of Participation
During the period January 15, 2010 through January 15, 2011, 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
Peter K. Smith, MD	Consulting: Bayer HealthCare Pharmaceuticals Inc., CSL Behring, Cubist Pharmaceuticals, Inc.
Ian J. Welsby, MD, MBBS, FRCA	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: 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: Patrick J. Crowley, Senior Director, Operations; Jodi Andrews, Foundation Manager; 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 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, Educational Concepts in Medicine, 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.