CME/CE QUIZ

Supplements and Featured Publications, Healthcare Economics of Effective Anticoagulation, Volume 10, Issue 10 Suppl

CME/CE QUESTIONS

Continuing Medical Education Accreditation

The University of Cincinnati College of Medicine designates this educational activity for a maximum of 3 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians.

Continuing Pharmacy Education Accreditation

Pharmacy Times

is approved by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 3 contact hours (0.2 CEUs) under the ACPE universal program number of 290-999-04-034-H01.

Instructions

After reading "Healthcare Economics of Effective Anticoagulation," complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (with a minimum score of 70%) the examination at the conclusion of the program.

1. Therapy with heparin for 1 week plus oral anticoagulation continuing for at least 3 months has been shown to reduce the risk of recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE) (vs placebo) by about:

  • 40% to 50%
  • 80% to 90%

2. Currently, the most effective method of increasing quality, reducing complications, and limiting total costs with warfarin anticoagulation for stroke prevention is:

  • Web-based anticoagulation services
  • Prior authorization limits on warfarin prescribing

3. On a national level, about what percentage of patients with atrial fibrillation (AF) who are eligible for stroke prophylaxis with anticoagulants receive warfarin?

  • 50%
  • 95%

4. The prevalence of AF in those aged 80 years and older is:

  • 4% to 5%
  • 15% to 20%

5. According to an analysis by Taylor et al 1996 (and updated to 1999 dollars by the American Heart Association), the mean per-patient lifetime cost of an ischemic stroke is approximately:

  • $88 000
  • $224 000

6. Stroke risk reduction in patients with AF has been documented in placebo-controlled trials with both warfarin and aspirin. Compared with placebo or control, aspirin reduced related risk of stroke by 22%. Compared with aspirin, wafarin-related risk reduction is:

  • 36%
  • Equal or slightly less

7. Underutilization of warfarin in the setting of stroke prophylaxis in patients with AF is most directly attributable to:

  • Narrow therapeutic window and need for coagulation monitoring
  • Lack of approved national clinical guidelines for this indication

8. About what percentage of US patients with AF who are currently receiving warfarin are actually maintained within the target international normalized ratio (INR) of 2.0 to 3.0?

  • 50%
  • 95%

9. Patients with INRs below 2.0 while taking warfarin not only have an increased risk of stroke, they also:

  • Have an increased risk of minor bleeding
  • All of the above

10. How many people die from PE related to DVT every year in the United States?

  • 10 000
  • 500 000

11. The risk of fatal venous thromboemboli (VTE) can be as high as 5% in certain ultra-high-risk populations such as:

  • Patients having major orthopedic surgery
  • Elderly diabetic patients on long airline flights

12. For surgical patients at high risk of VTE and PE, individualized therapy is best, and the current evidence base supports a course of anticoagulation that lasts up to:

  • 48 hours
  • As long as 30 days

13. What makes the use of low-molecular-weight heparin (LMWH) problematic as prophylaxis of DVT?

  • Need for parenteral administration
  • All of the above

14. Ximelagatran is:

  • A once-a-week subcutaneous synthetic pentasaccharide
  • A nematode anticoagulation peptide

15. In the setting of VTE prophylaxis following orthopedic surgery, ximelagatran has shown similar or superior efficacy in comparisons with LMWH or well-controlled warfarin therapy.

  • False

16. The availability of an oral anticoagulant that does not require life-long coagulation monitoring but provides efficacy on par with warfarin has the potential to reduce total health system costs for strokes by:

  • Increase the percentage of high-risk patients who receive preventive therapy
  • Decrease the need for anticoagulation clinics and INR testing
  • All of the above

17. The Stroke Prevention using Oral Thrombin Inhibitor in nonvalvular Atrial Fibrillation (SPORTIF) studies with fixed-dose ximelagatran in over 7000 patients with nonvalvular AF showed that this agent's efficacy in preventing stroke was:

  • Equal to strictly controlled warfarin
  • Inferior to dose-adjusted warfarin
  • a and d

18. What potential pharmacokinetic advantages does idraparinux have over warfarin?

  • 80-hour half-life (allowing once-weekly dosing)
  • All of the above

19. Why is warfarin utilization so low in the warfarin-eligible very elderly patients with AF who are at highest risk for stroke?

  • Risk of heart attack
  • All of the above

20. In patients with AF, aspirin is considered a suitable alternative to oral anticoagulation in:

  • Certain patients at lower risk for stroke
  • Patients with contraindications to warfarin
  • None of the above

Testing and Grading Procedures

  • Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CE credits earned. This form should be safeguarded and may be used as documentation of credits earned.

Participants receiving a failing grade on any exam will be notified and permitted to take 1 reexamination at no cost.

  • All answers should be recorded on the answer form. Please print clearly to ensure receipt of CE credit.

Pharmacy Times

To receive credit certification electronically, please provide your e-mail address. Detach and mail completed exam form with your $10.00 payment to CE Department, 405 Glenn Drive, Suite 4, Sterling, VA 20164-4432; or fax to 703-404-1801.

  • Take the test online for FREE at www.pharmacytimes.com and receive immediate grading and CE credits, and download your CE statement of credit.

Please photocopy the test form for additional test takers.

Pharmacy Times

is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 3 contact hours (0.3 CEUs) under the ACPE universal program number of 290-999-04-034-H01. The program is available for CE credit through October 31, 2005.

Healthcare Economics of Effective Anticoagulation

GOAL

To provide participants with current information regarding anticoagulation therapy, its costs, and the impact underutilization and underdosing has on patients and the healthcare community.

TARGET AUDIENCE

This activity is intended for physicians, medical directors, pharmacists, pharmacy directors, primary care physicians, and specialists in hematology and internal medicine.

EDUCATIONAL OBJECTIVES

After participating in this activity, participants should be better able to:

Define the need for and prevalence of anticoagulation therapy.

  • Discuss the current research trends in anticoagulation and emerging anticoagulation therapies.

Compare the cost effectiveness of anticoagulation therapies.

  • Explore the impact of underutilization and underdosing of anticoagulation therapies on payers and patients.

CONTINUING MEDICAL EDUCATION ACCREDITATION

The University of Cincinnati College of Medicine designates this activity for a maximum of 3 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Release Date: October 31, 2004. Expiration Date: October 31, 2005.

CONTINUING PHARMACY EDUCATION ACCREDITATION

Pharmacy Times

is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 3 contact hours (0.3 CEUs) under the ACPE universal program number of 209-999-04-034-H01. Release Date: October 31, 2004. Expiration Date: October 31, 2005.

FUNDING

This program is supported by an unrestricted educational grant from AstraZeneca.