This product is an ASHP Learning Center activity.
Accreditation for Pharmacists
The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.
Target Audience
This activity is intended for pharmacists seeking to expand their knowledge and skills in anticoagulation therapy management.
Activity Overview
This self-guided, online learning activity is intended for pharmacists and is designed to provide focused education about anticoagulation therapy management. The curriculum includes the following foundational information:
- Coagulation cascade and corresponding targets of antithrombotic mechanisms of action
- Safety and quality influences on the care of patients receiving anticoagulation
- The use of anticoagulants in acute care, ambulatory, and perioperative settings
- Patient and caregiver education
- Therapy considerations unique to special patient populations
- Adverse effect monitoring and management
- Interpretation of laboratory assays and application to care
- Anticoagulation stewardship
Throughout the certificate, the skills needed to be an effective anticoagulation practitioner are applied through case study questions with practical, real-world situations explored, and treatment approaches explained. Upon completion of all of the modules, learners should have gained the knowledge and skills to be successful in managing the therapy of patients receiving anticoagulants.
Professional Certificate Requirement
Once a learner has completed the educational curriculum, they will have the opportunity to complete an online comprehensive exam. Once the learner completes the exam (minimum 80% passing rate; unlimited attempts permitted), they will earn the professional certificate.
Educational Activities
Introduction to Anticoagulation
ACPE #: 0204-0000-23-700-H01-P
CE Hours: 2 contact hours
Activity Type: Application-based
Learning Objectives:
- Identify the components of the intrinsic and extrinsic clotting cascade.
- Describe how fibrinolysis occurs in the human body.
- Explain anticoagulant mechanisms of action in relationship to the clotting cascade.
- Describe milestones in the evolving use and management of anticoagulation therapy.
- Identify regulatory and accreditation influences on anticoagulation management.
- Explain the importance of pharmacists in optimizing the overall anticoagulation management plan.
Heparin, Low Molecular Weight Heparin, and Venous Thromboembolism Prophylaxis
ACPE #: 0204-0000-23-701-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based
Learning Objectives:
- Identify the differences among unfractionated heparin, low molecular weight heparin (LMWH), and fondaparinux.
- Explain how to initiate and monitor heparin, low molecular weight heparin, and fondaparinux for various indications.
- Recommend dose adjustments of heparin, low molecular weight heparin, and fondaparinux based on patient specific considerations.
- Apply a venous thromboembolism risk assessment model to determine risk for venous thrombosis in medical or surgical patients.
- Compare the difference in safety and efficacy of venous thromboembolism prophylaxis regimens in medical or surgical patients.
- Design an optimal VTE prophylaxis regimen in medical or surgical patients.
Arterial Disease and Venous Thromboembolism Treatment
ACPE #: 0204-0000-23-702-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based
Learning Objectives:
- Describe how acute venous thromboembolism (VTE) is diagnosed.
- Identify evidence-based anticoagulant options with recommended dosing for initial VTE treatment.
- Design an individualized anticoagulant plan for a patient with an acute VTE case including risk-benefit assessment and determination of duration of anticoagulant therapy.
- Compare and contrast the key characteristics and treatment considerations for arterial versus venous thromboembolism.
- Design an appropriate antithrombotic treatment regimen for coronary artery disease patients who also have either atrial fibrillation or venous thromboembolism.
- Compare and contrast the key characteristics and treatment considerations for arterial versus venous thromboembolism.
- Design an appropriate antithrombotic treatment regimen for peripheral artery disease and cardiovascular disease patients.
Thrombolytic Therapy
ACPE #: 0204-0000-23-703-H01-P
CE Hours: 2.25 contact hours
Activity Type: Application-based
Learning Objectives:
- Given a patient case, assess a patient’s potential benefits and risks, including contraindications, associated with thrombolytic therapy.
- Design an appropriate thrombolytic treatment plan for a patient with a life- or limb threatening thrombosis.
- Design a subsequent antithrombotic treatment plan for a patient with a life- or limb threatening thrombosis.
Warfarin and Focus on the Ambulatory Setting
ACPE #: 0204-0000-23-704-H01-P
CE Hours: 3.25 contact hours
Activity Type: Application-based
Learning Objectives:
- Select an appropriate starting dose, INR follow-up plan, and key patient education points for a patient starting warfarin therapy.
- Determine an appropriate dosing/management strategy based on the clinical situation when a patient on warfarin presents to the hospital.
- Determine an appropriate dosing/management strategy based on the clinical situation when a hospitalized patient on warfarin transitions to a different level of care (critical care, sub-acute, home).
- Develop an effective management strategy when a patient experiences a clinically significant drug-drug or dietary interaction.
- Formulate an effective management strategy when presented with an ambulatory patient struggling with warfarin therapy.
- Identify the key components, characteristics, and activities for management of patients in a high-performing outpatient anticoagulation service.
- Modify a patient’s anticoagulation therapy in the management of warfarin, low molecular weight heparin (LMWH) and direct oral anticoagulant (DOAC) medications in an outpatient anticoagulation service.
- Summarize how to document care in the management of medications in an outpatient anticoagulation service.
Oral Direct Thrombin Inhibitors (DTI), Anti-Xa Agents, and Atrial Fibrillation
ACPE #: 0204-0000-23-705-H01-P
CE Hours: 2.75 contact hours
Activity Type: Application-based
Learning Objectives:
- Compare appropriate clinical and patient specific characteristics for DOAC and warfarin therapy.
- Identify potential organ system and drug interactions with DOACs.
- Design appropriate management strategies for a patient with organ system and drug interaction with DOACs.
- Develop a plan to successfully convert a patient from warfarin to a DOAC.
- Categorize an atrial fibrillation patient’s risk of stroke and bleeding in order to make treatment decisions.
- Develop an individualized anticoagulation plan for a patient with atrial fibrillation.
- Describe anticoagulation considerations related to ablations and anticoagulation alternatives in atrial fibrillation.
Anticoagulation in Special Populations
ACPE #: 0204-0000-23-706-H01-P
CE Hours: 4.25 contact hours
Activity Type: Application-based
Learning Objectives:
- Describe skills required by a pharmacist to assess if a patient requires special management considerations.
- Design monitoring parameters for a patient within a special population receiving an anticoagulant.
- Describe how factors for patients within special populations can alter risk for bleeding or thrombosis independent of direct effects on the anticoagulation regimen.
- Analyze anticoagulation-related outcomes in the obese patient population.
- Select appropriate anticoagulant therapy for patients with obesity.
- Select appropriate anticoagulant therapy in a patient within a special population (renal failure).
- Analyze anticoagulation-related outcomes in patients with renal insufficiency.
- Select appropriate anticoagulant therapy in patients with renal insufficiency.
- Describe how factors associated with the geriatric patient population can alter risks of bleeding and thrombosis independent of direct effects on the anticoagulation regimen.
- Analyze anticoagulation-related outcomes in the geriatric patient population.
- Select appropriate anticoagulant therapy for patients in the geriatric patient population.
- Discuss characteristics in pregnant women that put them at higher risk for VTE.
- Apply key components for managing a pregnant patient with a VTE before, during, and after delivery.
- Apply components and activities for managing a pediatric patient requiring anticoagulation therapy for a VTE.
Mechanical Devices and Focus on the Acute Care Setting
ACPE #: 0204-0000-23-707-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based
Learning Objectives:
- Discuss common, current medical devices that require anticoagulation.
- Analyze a patient’s device-specific anticoagulation regimen.
- Design a patient- and device-specific anticoagulation regimen.
- Review common, current medical devices that require anticoagulation.
- Explain challenges that can occur with anticoagulants in the acutely and critically ill patient.
- Describe characteristics of effective anticoagulation management specific to acutely ill patient.
- Summarize what a pharmacist needs to consider in adapting anticoagulant therapy to the acutely ill patient.
Heparin Induced Thrombocytopenia (HIT) Treatment and Hypercoagulable Conditions
ACPE #: 0204-0000-23-708-H01-P
CE Hours: 3.75 contact hours
Activity Type: Application-based
Learning Objectives:
- Describe the pathophysiology and approaches to recognize heparin-induced thrombocytopenia (HIT).
- Discuss approaches to managing HIT.
- Discuss how to initiate and manage anticoagulation therapy in HIT.
- Discuss how to initiate and manage parenteral direct thrombin inhibitors.
- Describe the clinical presentations and testing considerations for hypercoagulable conditions.
- Develop a management plan to mitigate the risk of thrombosis in patients.
- Assess the role of cancer as a hypercoagulable state and the use of risk assessment scores to determine management strategies.
- Assess the role of cancer as a hypercoagulable state.
- Apply risk assessment scores to determine anticoagulation management strategies in patients with cancer.
Laboratory Assessments
ACPE #: 0204-0000-23-709-H01-P
CE Hours: 3 contact hours
Activity Type: Application-based
Learning Objectives:
- Explain analytical tests utilized in the assessment and management of anticoagulant agents.
- Summarize the limitations of anticoagulant assays.
- Design an anticoagulation management plan that incorporates assays for decision support.
Reversing Anticoagulation and Peri-Operative Management
ACPE #: 0204-0000-23-710-H01-P
CE Hours: 4.25 contact hours
Activity Type: Application-based
Learning Objectives:
- Describe potential bleeding challenges during anticoagulation therapy.
- Design an anticoagulation agent-specific reversal plan.
- Summarize available anticoagulant medications and ways to reverse their effects.
- Describe the various agents used to reverse anticoagulant effects.
- Summarize invasive procedures and related risks for bleeding and thrombotic complications.
- Design an anticoagulation management approach when an invasive procedure is planned.
- Analyze a patient’s specific anticoagulation regimen and estimate when effects may be absent.
Skills for Managing Anticoagulation Therapy
ACPE #: 0204-0000-23-711-H01-P
CE Hours: 2.5 contact hours
Activity Type: Application-based
Learning Objectives:
- Discuss the skill set needed for initiating and developing anticoagulation therapy management plans.
- Describe skills for assessing and adjusting anticoagulation management plans.
- Re-define a pharmacist’s role in managing anticoagulation therapy.
- Name key concepts learned in managing anticoagulation therapy.
- Prepare a plan for continued self-development to evolve as an anticoagulation therapy provider.
- Summarize a pharmacist’s role in managing anticoagulation therapy.
- Apply concepts learned in managing anticoagulation therapy.
- Prepare a plan for continued self-development to evolve as an anticoagulation therapy provider.
Antithrombotic Stewardship
ACPE #: 0204-0000-23-712-H01-P
CE Hours: 1 contact hour
Activity Type: Application-based
Learning Objectives:
- Describe the core elements of an antithrombotic stewardship program.
- Apply principles of antithrombotic stewardship within your current practice site.
Faculty Information
Craig J. Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS-AQ Cardiology, CACP
Director of Cardiovascular Services
Baptist Health Paducah
Cardiovascular Clinical Pharmacist
University of Kentucky Healthcare
Adjunct Assistant Professor, Department of Pharmacy Practice and Science
University of Kentucky College of Pharmacy
Lexington, Kentucky
William E. Dager, PharmD, BCPS, MCCM, FASHP, FACCP, FCSHP
Pharmacist Specialist
University of California, Davis Health System
Sacramento, California
Candice Garwood, PharmD, FCCP, BCPS, BCACP
Clinical Professor, Department of Pharmacy Practice
Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences
Ambulatory Care Clinical Pharmacy Specialist
Harper University Hospital
Detroit Medical Center
Detroit, Michigan
Jessica Grandoni, PharmD, BCPS
Clinical Pharmacy Specialist
Brigham and Women’s Hospital
Dana Farber Cancer Institute
Boston, Massachusetts
Michael P. Gulseth, PharmD, BCPS, FMSHP, FASHP
Anticoagulation Stewardship Director
PGY-2 Thrombosis and Hemostasis Management Residency Program Director
Sanford USD Medical Center
Sioux Falls, South Dakota
Tadd Hellwig, PharmD, BCPS, FASHP
Professor, Department of Pharmacy Practice
South Dakota State University College of Pharmacy and Allied Health Professions
Brookings, South Dakota
Clinical Pharmacist
Sanford USD Medical Center
Sioux Falls, South Dakota
Keri S. Kim, PharmD, MS CTS, BCPS, FNCS
Clinical Assistant Professor
Department of Pharmacy Practice
Clinical Pharmacist
University of Illinois Health
Chicago, Illinois
Tyree H. Kiser, PharmD, FCCP, FCCM, BCCCP, BCPS
Professor and Vice Chair, Department of Clinical Pharmacy
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
University of Colorado Anschutz Medical Campus
Clinical Pharmacy Specialist – Critical Care
University of Colorado Hospital
Aurora, Colorado
A. Josh Roberts, PharmD, BCPS, BCCP, AACC
Cardiology Pharmacist Specialist
University of California, Davis Health System
PGY2 Cardiology Pharmacy Residency Program Director
Clinical Professor of Pharmacy, Volunteer
UC San Francisco School of Pharmacy
Sacramento, California
Anne E. Rose, PharmD
Manager, Acute Care Services
University of Wisconsin Hospital and Clinics - UW Health
Madison, Wisconsin
Nancy L. Shapiro, PharmD, FCCP, BCACP, CACP
Clinical Professor and Associate Head for Education,
Department of Pharmacy Practice
University of Illinois at Chicago College of Pharmacy
Coordinator and Clinical Pharmacist, Antithrombosis Clinic
University of Illinois Hospital and Health Sciences System
Chicago, Illinois
Toby C. Trujillo, PharmD, FCCP, FAHA, BCPS Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Clinical Specialist - Anticoagulation/Cardiology
University of Colorado Hospital
Co-Director Anticoagulation Stewardship Program
University of Colorado Health
Aurora, Colorado
Ellen M. Uppuluri, PharmD, BCACP, CACP
Clinical Assistant Professor
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois
Relevant Financial Relationship Disclosure
In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company.
An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience.
The following persons in control of this activity’s content have relevant financial relationships:
Michael P. Gulseth, PharmD, BCPS, FASHP, FMSHP
- Janssen Pharmaceuticals: Speaker
- CSL Behring: Speakers bureau
- Diagnostica Stago, Inc. (“Stago U.S.”): Speakers bureau
All other persons in control of content do not have any relevant financial relationships with an ineligible company.
As defined by the Standards of Integrity and Independence definition of ineligible company. All relevant financial relationships have been mitigated prior to the CE activity.
Methods and CE Requirements
This online activity consists of a combined total of 13 learning modules. Pharmacists are eligible to receive a total of 38 hours of continuing education credit by completing all 13 modules within this professional certificate.
Participants must participate in the entire activity and complete the evaluation and all required components to claim continuing pharmacy education credit online at https://elearning.ashp.org. Follow the prompts to claim credit and view your statement of credit within 60 days of completing the activity.
Important Note – ACPE 60 Day Deadline:
Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP eProfile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity.
System Technical Requirements
ASHP learning content is delivered through your Web browser. For all learning content, you will need basic computer skills, ability to navigate web pages and stable internet connection. View the system requirements for learning activities.