Anticoagulation Reversal for Life-threatening Bleeding: A Case-based Presentation for the Critical Care Team

Released On
May 18, 2020

Expires On
May 18, 2021

Media Type

Completion Time
90 minutes

Acute Care, Cardiology, Critical Care, Education, Emergency Medicine, Endocrinology, Hospitalist, Nephrology, Pharmacy, Primary Care

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This activity is provided by the Society of Critical Care Medicine and Creative Educational Concepts.

This activity is supported in part by an independent education grant from Portola.

Credit Available

  • Physicians — maximum of 1.5 AMA PRA Category 1 Credit(s)
  • Nurses — 1.5 Nursing Contact Hours
  • Pharmacists — 1.5 continuing education hours

All other health care professionals completing this course will be issued a statement of participation.

Target Audience

This activity is designed to meet the educational needs of physicians, physician assistants, nurses, pharmacists, and other healthcare professionals.

Program Overview

Direct oral anticoagulants (DOACs) are life saving drugs for many patients, with transformative impact for patients with atrial fibrillation (AF) and thromboembolism, but they are not without risks. Anticoagulant adverse events have presented hurdles for both healthcare providers and patients, with bleeding complications at the forefront. Although bleeding with anticoagulants is rare, it can result in serious complications necessitating effective reversal strategies. As the treatment landscape of anticoagulant reversal evolves with new approvals, it is essential that the critical care team managing patients on anticoagulation therapy have an in-depth understanding of anticoagulation reversal agents for treatment and management of bleeding. Participants of this activity will gain understanding of DOACs, the risk of bleeding with DOACs, the differences and similarities of available novel reversal agents, and most importantly, practical strategies for implementing these agents into the critical care setting.

Learning Objectives

Upon completion of this activity, participants should be better able to:

  • Appraise the risk of bleeding with DOAC therapy, describe the risk factors associated with bleeding, and examine the strategies to mitigate these risks in order to improve patient and healthcare system outcomes.
  • Differentiate between available and emerging novel, specific anticoagulation reversal agents; assessing their differences and similarities in mechanism of action; and review the latest clinical trial data and practical administration considerations.
  • Evaluate the role of the critical care team in developing a protocol for implementation of novel anticoagulation reversal agents and design treatment strategies for patients with bleeding complications.


Gregory Piazza, MD

Assistant Professor of Medicine
Harvard Medical School
Associate Physician
Brigham and Women's Hospital
Cardiovascular Medicine
Boston, Massachusetts

John Fanikos, MBA, RPh

Assistant Professor of Clinical Pharmacy Practice
Northeastern University
Massachusetts College of Pharmacy
Director of Pharmacy Business and Financial Services
Brigham and Women’s Hospital
Boston, Massachusetts

Jorge Antonio Gutierrez, MD

Assistant Professor of Medicine
Department of Medicine; Division of Cardiology
Duke University
Durham, North Carolina

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Society of Critical Care Medicine and Creative Educational Concepts. The Society of Critical Care Medicine (SCCM) is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation


The Society of Critical Care Medicine designates this live educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


The Society of Critical Care Medicine (SCCM) is approved by the California Board of Registered Nursing, Provider No. 8181, for 1.5 contact hours. This activity is designated for 1.5 contact hours.


The Society of Critical Care Medicine (SCCM) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This application-based activity is approved for 1.5 contact hours (.15 CEUs) of continuing pharmacy education credit (0236-9999-20-203-H01-P).

Disclosures of Conflicts of Interest

All faculty participating in continuing medical education (CME) programs must disclose to the learners any financial interests with any commercial supporter or other relationships with manufacturers or providers of any product or service related to the content of their presentations. All content is peer reviewed to ensure its quality and independence. The following financial relationships are disclosed:


Susan H. Gitzinger, PharmD, MPA
Vice President, Business Development and Project Management
Creative Educational Concepts
No financial relationships

Vanessa Carranza, PharmD
Associate Director of Clinical Education
Creative Educational Concepts
No financial relationships

Diane Alberson, MEd
Education Manager
Society of Critical Care Medicine
No financial relationships

Audra Kubilius, CAE
Education Manager
Society of Critical Care Medicine
No financial relationships


John Fanikos, MBA, RPh
John Fanikos, MBA, RPh—has no relevant financial relationships to disclose in relation to the content of this activity.

Jorge Antonio Gutierrez, MD
Jorge Antonio Gutierrez, MD—has no relevant financial relationships to disclose in relation to the content of this activity.

Gregory Piazza, MD
Gregory Piazza, MD—has disclosed that he is a consultant for Pfizer, Portola, and Thrombolex. He also receives grant/research support from Bristol-Myers Squibb, BTG/EKOS, Daiichi-Sankyo, and Janssen.

Method of Participation

To receive a statement of credit, you must:

  1. Read the target audience, learning objectives, and author disclosures
  2. Review the full content of the activity and reflect upon its teaching
  3. Complete the questions and evaluation at the end of the activity
  4. Have a passing score of 70% on the post-test (you will have two [2] opportunities to complete the post-test)

Course Viewing Requirements

Supported Browsers:
Internet Explorer 8.0+ for Windows 2003, Vista, XP, Windows 7, Windows 8.1 and above
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6.0+ for Mac OSX 10.7 and above

Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above

Disclosure of Unlabeled Use

This activity may include discussions of products or devices that are not currently approved for use by the Food and Drug Administration (FDA), or are currently investigational.


It is the policy of CEC to ensure independence, balance, objectivity, scientific rigor, and integrity in their continuing education activities.

Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer's package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.

Fair balance is achieved through ongoing and thorough review of all presentation materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by CEC for any product or manufacturer identified.

Contact Information

For CME questions, please contact: CEC at