Activity Overview

Please read the following information about this continuing pharmacy education (CPE) activity before accessing the presentations using the link located at the bottom of this page.

Release Date: February 15, 2013          Expiration Date: March 3, 2014

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. This activity provides 2 hours (0.2 CEUs) of continuing pharmacy education credit (ACPE activity #0204-0000-12-438-H01-P).

Methods and Format

This is an online activity consisting of audio and slides, an assessment (post-test), and a course evaluation. Participants should claim continuing education credit for this internet-based educational activity only if they have not claimed credit for the live activity. Participants must view the entire presentation, take the activity assessment, and complete the course evaluation to receive continuing education credit. A minimum score of 70% is required on the test for credit to be awarded, and participants may print their official statements of continuing education credit immediately. The estimated time to complete this activity is 2 hours. This activity is provided free of charge.

Target Audience

This continuing pharmacy education activity was planned to meet the needs of pharmacists in a variety of practice settings, and it would be particularly beneficial for pharmacists, clinical specialists, pharmacy managers, leaders, and educators who are interested in emerging anticoagulant therapies, thrombosis, hematology, cardiology, and patient safety.

Activity Content

As the armamentarium of oral agents for prevention and treatment of thrombosis expands, practitioners must develop strategies to deal with the proper management of anticoagulant-related bleeding complications. Patients on oral anticoagulants who are at high risk of bleeding, are actively bleeding, or require emergency invasive procedures will need adjunct therapies that reverse or remove anticoagulant effects sooner than withholding the drug.

This activity will provide an overview of the challenges associated with oral anticoagulant therapies, including risks for developing bleeding complications. Therapeutic options for reversing the effects of oral anticoagulants will be described, focusing on new and emerging options for reversal. Using different patient scenarios, the faculty will explore practical issues in developing a reversal strategy for oral anticoagulant therapy.  

Learning Objectives

After attending this application-based educational activity, participants should be able to

  • Identify risk factors for bleeding complications with oral anticoagulant agents.
  • Apply strategies for minimizing the risk of bleeding with oral anticoagulant agents.
  • Describe the relative benefits and limitations of emergent anticoagulant reversal strategies.
  • Discuss the clinical evidence supporting the use of emergent anticoagulant reversal strategies.
  • Explain patient-specific treatment options for reversing the effects of oral anticoagulants using laboratory observations. 
  • Develop an approach to managing major bleeding in a patient on oral anticoagulation therapy.


Edith A. NutescuEdith A. Nutescu, Pharm.D., FCCP, Chair and Moderator

Clinical Professor
The University of Illinois at Chicago College of Pharmacy
Director, Antithrombosis Center
The University of Illinois Hospital and Health Sciences System
Chicago, Illinois

Edith A. Nutescu, Pharm.D., FCCP, is Clinical Professor in the Department of Pharmacy Practice, Department of Pharmacy Administration, and Center for Pharmacoeconomic Research at University of Illinois at Chicago College of Pharmacy. She also is Director of the Antithrombosis Center at the University of Illinois at Chicago Medical Center.

Dr. Nutescu earned her Doctor of Pharmacy degree with high honors at the University of Illinois at Chicago College of Pharmacy. After graduation, she went on to complete a pharmacy practice residency at Lutheran General Hospital–Advocate Health Care in Park Ridge, Illinois, and a primary care specialty residency at the University of Illinois at Chicago Medical Center, both accredited by the American Society of Health-System Pharmacists (ASHP).

Dr. Nutescu maintains an active clinical practice and research program. Her research and practice interests are in the areas of comparative effectiveness, health services, and outcomes, with emphasis in cardiovascular diseases, stroke, thrombosis, and antithrombotic therapies. She has authored over 100 scientific articles and book chapters, and she coauthored “Anticoagulation Therapy: A Point-of-care Guide” published by ASHP in 2011. Her research has been funded by the Department of Health and Human Services, Agency for Healthcare Research and Quality, and National Center for Research Resources. She is a recipient of the Ruth L. Kirchstein National Research Service Award for 2010-2012. She has lectured extensively both nationally and internationally on topics related to thrombosis, antithrombotic therapies, cardiovascular diseases, and stroke.

Dr. Nutescu serves on the editorial boards for Pharmacotherapy, Annals of Pharmacotherapy, and Thrombosis, and she previously was on the editorial board for the American Journal of Health-System Pharmacy.  Dr. Nutescu is active in several professional organizations, and she currently is a member of the Board of Regents for the American College of Clinical Pharmacy (ACCP), Board of Directors for Pharmacotherapy, and Board of Directors of the Anticoagulation Forum. She has served on the Oral Anticoagulant National Advisory Board of the National Consumers League Senior Outpatient Medication Safety Coalition and was the only pharmacist member nominated to serve on the steering committee of the National Quality Forum and The Joint Commission that developed “National Consensus Standards for the Prevention and Care of Venous Thrombosis.” Dr. Nutescu has been recognized as a fellow of ACCP and is the recipient of the ACCP 2009 Clinical Practice Award and ASHP Section of Home and Ambulatory Care Practitioners 2010 Distinguished Service Award.

William E. DagerWilliam E. Dager, Pharm.D., BCPS (AQ-Cardiology)

Pharmacist Specialist
UC Davis Medical Center
Sacramento, California

William E. Dager, Pharm.D., BCPS (AQ-Cardiology), is a pharmacist specialist at UC Davis Medical Center in Sacramento, California, where he is responsible for managing challenging cases in anticoagulation, pharmacokinetics, and critical care. He also is clinically active with the cardiology service and serves as the director of the postgraduate year two (PGY-2) residency in cardiology at UC Davis. In addition, Dr. Dager holds three academic positions. He is Clinical Professor of Pharmacy at the University of California, San Francisco (UCSF) School of Pharmacy and Clinical Professor of Medicine at the University of California, Davis (UC Davis) School of Medicine. He also serves as Clinical Professor at the Touro School of Pharmacy in Vallejo, California.

Dr. Dager earned his Doctor of Pharmacy degree at UCSF and completed a residency at the UC Davis Medical Center in Sacramento. In addition, he completed the University of Pittsburgh Nephrology Pharmaceutical Care Preceptorship. He is a board-certified pharmacotherapy specialist and fellow of the American College of Clinical Pharmacy (ACCP), American Society of Health-System Pharmacists (ASHP), California Society of Hospital Pharmacists, and Society of Critical Care Medicine (SCCM).

Dr. Dager's research interests focus on anticoagulation, critical care medicine, cardiovascular disease, and pharmacokinetics and pharmacodynamics. He has authored numerous articles, book chapters, and scientific reviews, and he coauthored “Anticoagulation Therapy: A Point-of-care Guide” published by ASHP in 2011. He also regularly makes presentations at national and international educational conferences. Dr. Dager serves as a reviewer and editorial board member for several medical journals, and he currently is chair of the Editorial Advisory Board Panel on Anticoagulation for The Annals of Pharmacotherapy. He has served as a site coordinator for the ASHP Research and Education Foundation Antithrombotic Pharmacotherapy Traineeship. Dr. Dager has received multiple teaching and professional awards, including the 2008 ACCP Best Practice Award.

James S. KalusJames S. Kalus, Pharm.D., BCPS (AQ-Cardiology)

Senior Manager, Patient Care Services
Department of Pharmacy Services
Henry Ford Hospital
Detroit, Michigan

James S. Kalus, Pharm.D., BCPS (AQ-Cardiology), is Senior Manager of Patient Care Services in the Department of Pharmacy Services at Henry Ford Hospital in Detroit, Michigan. In this position, Dr. Kalus is responsible for planning, implementing, and managing all pharmacy services related to patient care. He also is responsible for formulary management, evaluation, and control. In addition, he oversees staff training and development, as well as pharmacy research. He is Program Director for the postgraduate year one (PGY-1) residency at Henry Ford Hospital and precepts a general inpatient cardiology rotation for pharmacy students and residents.

Dr. Kalus earned both his Bachelor of Science in Pharmacy and Doctor of Pharmacy degrees at the University of Toledo in Toledo, Ohio. After completing a residency at the Medical University of South Carolina in Charleston, he did a two-year cardiovascular research fellowship through Hartford Hospital and the University of Connecticut in Hartford, Connecticut. Dr. Kalus was honored with the Outstanding Young Alumnus Award from the University of Toledo in 2009.

Before assuming his current position, Dr. Kalus served as Assistant Professor at the Eugene Applebaum College of Pharmacy and Health Sciences at Wayne State University in Detroit, Michigan. He is board certified as a pharmacotherapy specialist with added qualifications in cardiology.

In his research, Dr. Kalus focuses on cardiovascular disease, including the pathophysiology of atrial fibrillation (AF) occurring after cardiac surgery, novel strategies for the treatment and prevention of AF, and practice-based research related to anticoagulation. He has authored several textbook chapters and many articles published in peer-reviewed journals, including the American Journal of Health-System Pharmacy, Annals of Pharmacotherapy, Annals of Thoracic Surgery, Circulation, Journal of Electrocardiology, Journal of Hospital Medicine, Pharmacoeconomics, and Pharmacotherapy. He also serves on the editorial board of The Annals of Pharmacotherapy, Cardiology Panel.

Complementing the practice and research interests of Dr. Kalus is his involvement in professional associations. An active member of the American Society of Health-System Pharmacists (ASHP), he regularly speaks at educational sessions at the ASHP Midyear Clinical Meeting. As a member of the 2007 Research Affairs Committee of the American College of Clinical Pharmacy, he co-authored the report, “Recommended Education for Pharmacists as Competitive Clinical Scientists,” published in March 2009. The Southeastern Michigan Society of Health-System Pharmacists honored him with the 2008 Preceptor of the Year award and the 2006 Innovative Practice Award. He also has received the Drug Therapy Research Award from the ASHP Research and Education Foundation, and, in 2009, Dr. Kalus and his colleagues were finalists for the Foundation's Excellence in Medication Use Safety Award.

Disclosure Statement

In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support and the Accreditation Council for Pharmacy Education’s Guidelines for Standards for Commercial Support, ASHP Advantage requires that all individuals involved in the development of activity content disclose their relevant financial relationships. A person has a relevant financial relationship if the individual or his or her spouse/partner has a financial relationship (e.g., employee, consultant, research grant recipient, speakers bureau, or stockholder) in any amount occurring in the last 12 months with a commercial interest whose products or services may be discussed in the educational activity content over which the individual has control. The existence of these relationships is provided for the information of participants and should not be assumed to have an adverse impact on presentations.

All faculty and planners for ASHP Advantage education activities are qualified and selected by ASHP Advantage and required to disclose any relevant financial relationships with commercial interests. ASHP Advantage identifies and resolves conflicts of interest prior to an individual’s participation in development of content for an educational activity.

The faculty and planners report the following relationships:

Edith A. Nutescu, Pharm.D., FCCP, Activity Chair
Dr. Nutescu declares that she has served as a consultant for Daiichi-Sankyo Inc. and received a research grant and served as a consultant for Janssen Pharmaceuticals, Inc.

James S. Kalus, Pharm.D., BCPS (AQ-Cardiology)
Dr. Kalus declares that he has no relationships pertinent to this activity.

William E. Dager, Pharm.D., BCPS (AQ-Cardiology)
Dr. Dager declares that he has no relationships pertinent to this activity.

Susan R. Dombrowski, M.S., B.S.Pharm.
Ms. Dombrowski declares that she has no relationships pertinent to this activity.

Carla J. Brink, M.S., B.S.Pharm.
Ms. Brink declares that she has no relationships pertinent to this activity.

ASHP staff has no relevant financial relationships to disclose.

Agenda (120 minutes total)*

Oral Anticoagulant Therapies: A Balancing Act
Edith A. Nutescu, Pharm.D., FCCP
(25 minutes)

Options for Reversing the Effects of Oral Anticoagulants
James S. Kalus, Pharm.D., BCPS (AQ-Cardiology)
(50 minutes)

Practical Issues in Developing an Oral Anticoagulant Reversal Strategy
William E. Dager, Pharm.D., BCPS (AQ-Cardiology)
(30 minutes)

Questions and Answers
All Faculty
(optional, 15 minutes)

Launch Presentation

*Allow additional time to complete the assessment and evaluation.

Download Assessment and Handout

Print the assessment (post-test) and handout of slides for your reference; however, your assessment must be submitted online.

Process CE

When you reach the end of the activity, follow instructions to complete the online process (i.e., take assessment test and complete evaluation) and obtain CE credit.

Additional Resources

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