Credits:
0.5 CME
Is fibrinogen deficiency a fundamental risk factor for cardiac surgery? In an interview with Blood CME Center staff, Aryeh Shander, MD, FCCM, FCCP, offers his expert opinion on the role of fibrinogen in surgical hemostasis. As part of his discussion, Dr. Shander reflects on recent data correlating fibrinogen levels with the risk of bleeding, particularly in the cardiac surgery population, as well as current and emerging strategies for achieving and maintaining optimal hemostasis.
Credits:
1.0 CME
If you are attending the Annual Meeting of the American Society of Pediatric Hematology/Oncology (ASPHO) in Montreal, please join us at a CME luncheon symposium on Thursday, April 8, 2010, at 12:30 pm at Fairmont the Queen Elizabeth Hotel.
People with severe hemophilia infuse themselves with clotting factor therapy-factor VIII or factor IX-but as many as 30% of hemophilia A patients can develop inhibitors. The development of inhibitors represents a major complication in the treatment of patients with severe hemophilia. A multidisciplinary team of experts will explore the key issues surrounding the management of patients with hemophilia and inhibitors at this CME luncheon symposium. Victor S. Blanchette, MD, FRCP, Head of the Division of Hematology/Oncology at the Hospital for Sick Children, Michael Recht, MD, PhD, Director of the Hemophilia Center at Oregon Health & Science University, and Amy D. Shapiro, MD, Medical Director of Indiana Hemophilia and Thrombosis Center, will join forces to consider such issues as the pathogenicity and clinical consequences of inhibitors, the prevention of joint disease, the significance of prophylactic therapy, and currently available treatment options.
Credits:
1.0 CME
Expires: 1/2011
Listen to Ian J. Welsby, MD, MBBS, FRCA, and Peter K. Smith, MD, both on the faculty at Duke University Medical Center in Durham, North Carolina, discuss the essential aspects of hemostasis, as well as current and emerging therapeutic options for restoring hemostasis in cardiac surgery patients. This presentation includes a comprehensive overview of hemostasis, available treatments for coagulopathy, frequently encountered complications in cardiac surgery, and strategies for managing perioperative bleeding.
Credits:
0.5 CME / 0.5 CNE
Expires: 12/2010
Listen to expert commentary derived from the symposium titled “Multidisciplinary Team Care in Hemophilia: Elective Orthopedic Surgery in Patients With Inhibitors,” which was held at the National Hemophilia Foundation (NHF) Annual Meeting on October 31, 2009. In this CME activity, Prasad Mathew, MD, FAAP, and James V. Luck, Jr, MD, offer their perspective as team members of hemophilia treatment center (HTC) programs. Each clinician addresses the specific needs of hemophilia A patients with inhibitors who elect to undergo orthopedic surgery and the challenges faced by the HTC team as a result of that decision.
Credits:
Not for credit
Are there hemostatic challenges unique to cardiac surgery? An anesthesiologist and a surgeon discuss important factors in perioperative cardiac bleeding and the clinician’s ability to mitigate against those factors in this informative Q&A exchange. Topics covered include strategies for managing hemostasis; the debate concerning optimal fibrinogen levels; benefits and drawbacks to using allogeneic blood products for the correction of low fibrinogen levels; how to measure clot formation intraoperatively and postoperatively; as well as recent developments in point-of-care diagnostics, including ROTEM, and how these developments will likely impact the perioperative management of hemostasis.
Credits:
Not for credit
What type of care is required of hemophilia A patients with inhibitors who elect to undergo orthopedic surgery? A nurse and a physical therapist discuss the preoperative and postoperative challenges such patients present to the hemophilia treatment center team. Issues addressed in this podcast include the importance of patient education, dosing of bypassing agents, calculation of factor requirements, preoperative and postoperative exercise programs, and the importance of physical therapy in the surgical patient’s rehabilitative process. An actual patient with inhibitors provides his viewpoint on the orthopedic surgery he has had and discusses his concerns, rehabilitation program, and quality-of-life issues.
Credits:
Not for credit
The list of anticoagulants used in the United States is growing, with several agents recently approved in the last decade and numerous others awaiting approval. Cardiothoracic anesthesiologist Jerrold H. Levy offers insights on both conventional and novel anticoagulants and the challenges they pose for clinicians who must manage the hemostatic stability of their patients in emergent situations or when urgent invasive procedures are required. This learning activity explores issues in anticoagulant therapy, including risks and benefits of old and new agents, strategies for reversal of therapy, and ways to monitor reversal of anticoagulant effects.
Credits:
Not for credit
Nearly 1½ centuries ago, the clinical manifestations of drug-induced thrombocytopenia (DIT) were first described. Since that time, the disorder has become increasingly common. Despite the availability of testing to identify implicated agents in DIT, a high index of suspicion and a patient history of drug exposure remain important elements of effective assessment and management. Patricia A. Ford, MD, examines the various mechanisms of this disorder as well as new and upcoming treatments for it.
Credits:
0.5 CME / 0.5 CNE
Expires: 9/2010
This learning activity addresses the issue of coagulopathy in trauma care, noting specifically the role of shock as an inducer of acute traumatic coagulopathy and providing a breakdown of contributing physiologic events. Implementation of a trauma exsanguination protocol has been shown to improve patient survival, minimize costly delays, and reduce blood product consumption. Trauma surgeon Bryan A. Cotton presents the components of such a protocol, as well as current recommendations for optimal blood product ratios. Additional commentary from trauma care specialists Martin A. Schreiber, MD, FACS, and Richard P. Dutton, MD, MBA, sheds light on the off-label use of recombinant factor VIIa to treat trauma patients and emerging strategies for the treatment of the coagulopathy of trauma.
Credits:
Not for credit
In the United States, the demand for donated organs far exceeds the supply. In this learning activity, Deborah M. Stein, MD, MPH, FACS, draws on research she has conducted with colleagues at the R Adams Cowley Shock Trauma Center concerning successful organ donation among patients with nonsurvivable traumatic brain injury and severe coagulopathy or active hemorrhage. Approximately 3 of every 4 organs transplanted are removed from deceased donors. Dr. Stein focuses on the ways that patients with devastating neurologic outcomes are clinically managed to allow for successful donation, and she addresses ethical and economic considerations.
Credits:
0.5 CME
Expires: 9/2010
Listen to Aryeh Shander, MD, FCCM, FCCP, and William C. Chapman, MD, address questions on the benefits and risks of available topical thrombin preparations. As part of their discussion, these blood management experts draw on their clinical experiences to reflect on the controversies surrounding bovine thrombin exposure, as well as the role topical hemostatic agents can play in achieving surgical hemostasis.
Please disable any pop-up blockers before viewing this activity.
Credits:
0.25 CME
Expires: 9/2010
In this premier vodcast activity of the Blood CME Center, Martin A. Schreiber, MD, FACS, discusses the mechanisms that contribute to the acute coagulopathy of trauma. In examining the physiology of trauma-shock, Dr. Schreiber specifically notes the role of protein C, thrombomodulin, hypothermia, and dilution and their effects on the coagulation system following trauma. Drs. Bryan A. Cotton and Richard P. Dutton contribute to the activity with commentary on evolving resuscitation strategies for managing the coagulopathy of trauma and the direction of research in this clinical area.
Credits:
Not for credit
Coagulopathy is often a life-threatening complication in trauma patients. This activity looks at two studies that evaluated strategies for limiting blood transfusion and administration of large volumes of other resuscitative fluids while improving patient outcomes.
Credits:
0.5 CME
Expires: 7/2010
Listen to Lawrence T. Goodnough, MD, discuss the risks of perioperative anemia, options for minimizing transfusions, and management strategies to control anemia. Perioperative anemia carries many risks for a variety of patients in the elective surgery setting and managing it preoperatively can minimize the number of blood transfusions administered to this patient population.
Credits:
Not for credit
Trauma surgeons Bryan A. Cotton and Martin A. Schreiber participate in a Q&A exchange on conventional and emerging strategies for managing the coagulopathy of trauma. Long regarded as iatrogenic in nature, the coagulopathy of trauma is now being recognized as a condition that occurs almost immediately following injury. In this podcast activity, Drs. Cotton and Schreiber draw on their many years of combined experience in trauma and critical care surgery to comment on the shifting treatment paradigm and field questions on such issues as clinician perceptions regarding trauma coagulopathy, treatment protocols, blood product ratios, and future directions in trauma care.
Credits:
Not for credit
Trauma anesthesiologist Richard P. Dutton, MD, MBA, draws on his clinical experiences at the R Adams Cowley Shock Trauma Center, the largest-volume trauma center in the United States, to discuss the coagulopathy of trauma and the ways in which treatment strategies for this condition have evolved over time. Clinicians’ understanding of the coagulopathy of trauma has advanced over the past 5 to 10 years. In this podcast activity, Dr. Dutton specifically addresses the early coagulopathy of trauma as a distinct entity, damage control surgery, resuscitation strategies and the use of antifibrinolytic therapies, and the future role of recombinant factor VIIa in resuscitation and coagulopathy.
Credits:
Not for credit
In this Q&A interview, Aryeh Shander, MD, FCCM, FCCP, discusses the challenges that preoperative anemia presents to surgical team members and other clinicians. As part of this podcast, Dr. Shander addresses the association between outcomes and etiology of anemia, the importance of low hemoglobin level and symptoms in the treatment of preoperative anemia, and therapeutic choices for patients with preoperative anemia that is associated with chronic comorbidities such as kidney disease, HIV, and sickle cell disease.
Credits:
0.75 CME
Expires: 6/2010
Listen to Aryeh Shander, MD, FCCM, FCCP, outline ways to manage perioperative anemia and discuss why this condition should be a concern for clinicians. Anemia is a neglected diagnosis, with multiple causes. Thought to be a condition primarily affecting underdeveloped populations, anemia is also prevalent in Western countries. Perioperative anemia is associated with increased morbidity and mortality, and elderly patients are among those at greatest risk.
Credits:
0.5 CME
Expires: 6/2010
Trauma anesthesiologist Richard P. Dutton, MD, MBA, addresses a series of questions on the mechanistic theory of coagulopathy, evolving resuscitation techniques, and recent changes in the way clinicians regard the early coagulopathy of trauma. Hemorrhage is a major contributor to the dilemma of traumatic injury and its subsequent care, and patients with massive traumatic hemorrhage inevitably develop coagulopathy. More than 80% of the trauma deaths that occur in the OR do so as a result of hemorrhage. The acquired coagulopathy of trauma is an important clinical issue that continues to be studied and debated.
Credits:
0.5 CME
Expires: 5/2010
Listen to vascular surgeon Jeffrey H. Lawson, MD, PhD, discuss the issues surrounding today’s therapeutic options for controlling intraoperative bleeding, as well as current protocols designed to achieve and maintain optimal surgical hemostasis. As part of his discussion, Dr. Lawson differentiates the available topical hemostatic agents and addresses the benefits and risks of recombinant technology in managing surgical hemostasis.
Credits:
Not for credit
Blood management expert Jerrold Levy, MD, FAHA, addresses questions concerning today’s therapeutic options for achieving and maintaining intraoperative hemostasis. As part of this activity, Dr. Levy discusses current recommendations for selecting topical agents and the value of hemostatic tests both inside and outside of the OR. Additional topics discussed by Dr. Levy include the clinical significance of acquired coagulopathy secondary to bovine thrombin exposure, individual dynamics that may predispose a patient to intraoperative bleeding, and the challenges of maintaining hemostasis in the surgical setting.
Credits:
0.5 CME / 0.6 CNE
Expires: 5/2010
Aryeh Shander, MD, FCCM, FCCP, addresses questions about acquired inhibitors to factor VIII and the clinical challenges presented by this coagulation disorder, particularly as it concerns elderly patients in the perioperative setting. Spontaneously acquired inhibitors to factor VIII occur rarely, with no known etiology in approximately half of all diagnosed cases. However, the majority of cases occur in older adults. In this Q&A podcast, Dr. Shander discusses the difficulties inherent in diagnosing acquired coagulopathies and treatment strategies specifically for managing acquired inhibitors to factor VIII. A case study complements this learning activity and reinforces key points raised in the Q&A.
Credits:
1.75 CME / 1.7 CNE
Expires: Expired
Trauma surgeon Bryan A. Cotton, MD, FACS; hematologist B. Gail Macik, MD; and colorectal surgeon Ronald A. White, MD, JD, discuss the diagnostic and treatment strategies for congenital and acquired hemophilia as they meet the challenges presented by two fictitious cases that comprise one nightmare weekend in the ED and the OR of a small community hospital. In sharing professional insights about two relatively rare bleeding disorders, these experts address the difficulties inherent in performing diagnostic workups with limited laboratory resources; making appropriate treatment choices; and preparing patients for elective or emergent surgery.
Credits:
0.5 CME / 0.6 CNE
Expires: Expired
Listen to Michael J. Paidas, MD, an expert in blood disorders, discuss the identification and clinical management of postpartum acquired hemophilia. Although the development of inhibitors in the postpartum period is a rare occurrence, it can be a potentially life-threatening complication. As part of his discussion, Dr. Paidas addresses the association between prompt diagnosis and successful outcome in postpartum acquired hemophilia and outlines treatment strategies to achieve hemostasis and eradicate inhibitors.
Credits:
Up to 2.25 CME
Expires: Expired
Choose your path! Learn expert approaches for managing patients with acquired coagulopathy from the perspective of an anesthesiologist, a pathologist/transfusion specialist, and a surgeon. Two tracks, consisting of 4 modules each, cover such subjects as the physiology and evolving models of hemostasis and the ways in which acquired coagulopathy is managed and treated. You can earn up to 2.25 CME credits in the anesthesiology track and up to 2.0 CME credits in the surgery track.
Credits:
Not for credit
Trauma care specialists Richard P. Dutton, MD, MBA; John B. Holcomb, MD, FACS; and Deborah M. Stein, MD, MPH, FACS; address questions on such topics as the role of coagulopathy in trauma, pitfalls of early aggressive treatment, and ways to improve patient outcomes. A major development in trauma care over the past 5 years has been the recognition that coagulopathy is an important component of early trauma, and the level of coagulopathy present at the time of admission correlates with outcomes among seriously injured trauma patients. What has been learned in the trauma care setting about coagulopathy has relevance to and application in other surgical disciplines.
Credits:
0.5 CME
Expires: Expired
Listen to John B. Holcomb, MD, FACS, a Trauma Consultant for the Surgeon General, discuss the potential consequences of traumatic combat injury and the measures taken to prevent these consequences. As part of his discussion, Dr. Holcomb describes the differences between current and past patterns of combat injury, the signs and symptoms of hemorrhagic shock, and the effects of various types of transfusion and other treatments.
Credits:
Not for credit
Listen to Richard P. Dutton, MD, MBA, in this archived version of a previously recorded Webinar, discuss hemostatic challenges and the tools with which perioperative impairment of hemostasis may be restored. The case-based activity presents a surgical challenge for assessment and review by surgeons and anesthesiologists, who offer insights on how to manage complications attributed to bleeding and clotting.
This archived Webinar was recorded during a live CME Webinar that was held on April 23, 2008.
Credits:
Not for credit
Richard P. Dutton, MD, MBA; John B. Holcomb, MD, FACS; and Deborah M. Stein, MD, MPH, FACS; discuss the evolving clinical perceptions of acquired coagulopathy and how it is treated. As part of their discussion, these trauma specialists address the use of prohemostatic agents in military and civilian practice, hypotensive resuscitation practices, and standard procedures for utilizing off-label recombinant factor VIIa.
Credits:
0.5 CME
Expires: Expired
Listen to Deborah M. Stein, MD, MPH, FACS, discuss aspects of traumatic brain injury, including epidemiology, etiology, and treatment options for coagulopathy. Trauma is the third leading cause of death overall and the leading cause of death among those aged 1 to 44 years in the United States. Trauma care is continually evolving to enhance outcomes. This CEnow™ explores traumatic brain injury with acquired coagulopathy as a significant clinical challenge with far-reaching implications.
Credits:
Not for credit
Listen to Maureane Hoffman, MD, PhD, discuss the risks associated with blood transfusion and the clinical indicators for this treatment modality. As part of her discussion, Dr. Hoffman addresses the role of treatment guidelines and laboratory values in the decision to transfuse, techniques to reduce transfusion, and uses of nontransfusional therapies.
Credits:
1.5 CME
Expires: Expired
Two experts in blood management, Jeffrey H. Lawson, MD, PhD, and Jerrold H. Levy, MD, FAHA, exchange their thoughts in this forum and moderated roundtable discussion on some of the hemostatic challenges currently facing the anesthesiology/surgical team in the OR and throughout recovery. The subjects addressed in this learning activity include stratification of patients’ preoperative risk for bleeding, the prognosis for patients with acquired coagulopathy from surgery, and pharmacologic interventions that can be employed to achieve optimal hemostasis.
Credits:
Not for credit
Listen to Jeffrey H. Lawson, MD, PhD, share his views on the management of excessive bleeding in surgical patients, with a focus on vascular surgery. Dr. Lawson offers a philosophical perspective on hemostatic issues ranging from transfusion concerns and the practice of bloodless medicine to new strategies for achieving optimal hemostasis. Based, in part, on his experience as Director of Duke University’s Vascular Surgery Research Lab,
Dr. Lawson also outlines a paradigm for achieving hemostatic stability in surgical patients.
Credits:
0.5 CME
Expires: Expired
Listen to Jerrold H. Levy, MD, FAHA, a cardiothoracic anesthesiologist, share his insights on the prevention and management of surgical coagulopathy. Coagulopathy can prevent normal hemostatic mechanisms from functioning, thereby placing certain surgical patients at risk. It becomes incumbent on healthcare professionals who look after such patients to have appropriate measures in place by which to identify and treat acquired coagulation disorders both perioperatively and postoperatively.