Case Studies: Management of Anticoagulated Patients with Life-Threatening GI Bleeding

Tuesday, February 15, 2022, 12:00 AM - Wednesday, February 15, 2023, 11:00 PM

AMA PRA Category 1 Credits™ (1.25 hours), AMA PRA Category 1 Credits™ Designated (1.25 hours)


For the emergency physician, hospitalist, and critical care physician, upper GI or lower GI Bleeding can represent a life-threatening emergency in the anticoagulated patient presenting to the emergency department or intensive care unit,  In this CME-based educational program, the clinician is provided with multiple cases of patients with life-threatening GI bleeding

The development of direct oral anticoagulants (DOACs), such as dabigatran, betrixaban, rivaroxaban, apixaban, and edoxaban, represents an important advance in anticoagulation therapy. They are direct inhibitors against a specific target of the coagulation system, i.e., thrombin (FIIa) for dabigatran, and activated factor X (FXa) for betrixaban, rivaroxaban, apixaban, and edoxaban. These agents have significant advantages over an older agent like warfarin, such as more predictable pharmacokinetic/pharmacodynamic (PK/PD) profiles, reduced susceptibility to food and drug interactions (yielding predictable and consistent anticoagulation levels) without the burdensome monitoring required with warfarin, and rapid onset and offset of action, which can aid in the management of patients requiring surgery or interventions. This is crucial, given the overall utilization of DOACs over the past several years. 

With the large increase in anticoagulant utilization, there has been a parallel increase in major bleeding events, especially gastrointestinal (GI) bleeding, requiring hospitalization. Clinicians must distinguish major from minor bleeding to appropriately manage major bleeding. GI bleeding in the anticoagulated patient may require  rapid action as these cases may be fatal, if not treated aggressively. Patients with life-threatening GI bleeding on an anticoagulant should be treated with a multi-pronged approach to maximize success. 

This program discusses the management of anticoagulated patients using a case-based approach for patients with life-threatening gastrointestinal bleeding. Case-based management provides the clinician with a clear and practical approach to severe GI bleeding in the anticoagulated patient.  Using two expert panel discussions, the integration of emergency care, critical care, and gastroenterology will provide the clinician learner the cognitive approach and management tools to provide outstanding care for their anticoagulated patient with GI Bleeding.

To register and review this enduring material activity, please go to: www.mededotg.com

There is no fee for viewing this activity.

1. Describe the mechanisms of action of the major anticoagulant classes with specific approaches to the management of life-threatening GI bleeding
2. Describe the essential treatment and specialist interventions, and implement treatment
3. Describe the elements of medical decision-making necessary to optimize patient outcomes

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Cincinnati Office of Continuing Medical Education, EMCREG-International and TotalCME, Inc.

The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.

The University of Cincinnati designates this online activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credits commensurate with the extent of their participation in the activity.


The opinions expressed during the live activity are those of the faculty and do not necessarily represent the views of the University of Cincinnati. The information is presented for the purpose of advancing the attendees’ professional development. 

Mitigation of Relevant Financial Relationships

The University of Cincinnati adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all financial relationships with ineligible entities (commercial interests) over the last 24-months. All relevant relationships have been mitigated prior to the commencement of the activity.

Information regarding the new updated ACCME Standards for Integrity and Independence in Accredited Continuing Education can be found on the ACCME website.

No faculty are available for this activity at this time.