July 17, 2013

DynaMed EBM Journal Volume 8, Issue 29

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: July 17, 2013

Expiration Date: July 17, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158K


Last week 672 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 364 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Apixaban Is as Effective for Treatment of Acute Venous Thromboembolism as Conventional Therapy and Reduces Bleeding Risk
Reference: N Engl J Med 2013 Jul 1 early online, (level 1 [likely reliable] evidence)

The standard treatment for venous thromboembolism (VTE) includes short-term treatment with a parenteral heparin-type anticoagulant (e.g. enoxaparin) and long-term treatment with warfarin, which requires frequent monitoring and dose adjustment. Newer anticoagulants, like fixed-dose oral factor Xa inhibitors, could simplify VTE management by reducing the need for injections and monitoring. The AMPLIFY trial compared the efficacy of the factor Xa inhibitor apixaban to conventional therapy for treatment of acute VTE in 5,395 adult patients.

Patients (mean age 57 years) with acute symptomatic proximal deep vein thrombosis or pulmonary embolism were randomized to 1 of 2 interventions and followed for 7 months. The conventional therapy group received enoxaparin 1 mg/kg subcutaneously every 12 hours for ≥ 5 days plus warfarin with target international normalized ratio (INR) 2-3 for 6 months. The apixaban group received apixaban 10 mg orally twice daily for the first 7 days, then 5 mg twice daily for 6 months. Blinding was maintained through placebo subcutaneous injections and placebo warfarin with sham INR monitoring. The primary outcome was a composite of recurrent symptomatic VTE and VTE-related death.

Primary outcome events occurred in 2.3% with apixaban vs. 2.7% with conventional therapy group (not significant). The apixaban group had lower rates of major bleeding (0.6% vs. 1.8%, p < 0.001, NNT 84) and clinically-relevant nonmajor bleeding (3.8% vs. 8%, p < 0.05, NNT 24). There were no significant differences in all-cause mortality (1.5% vs. 1.9%) or in serious adverse events. These data in patients with acute VTE add to recently published evidence regarding the efficacy and safety of long-term apixaban use for prevention of recurrent VTE (DynaMed EBM Focus Volume 8, Issue 11). Apixaban is currently FDA-approved only for use in patients with nonvalvular atrial fibrillation.

For more information, see the Anticoagulant therapy for venous thromboembolism topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

New Topic Added to DynaMed this Week

Sickle cell disease in adults and adolescents
Sickle cell disease in infants and children

Call for Peer Reviews

We are currently seeking reviewers for:

Hereditary hemorrhagic telangiectasia

Pelvic vein thrombosis in women

Learn more about DynaMed Contribution Opportunities

DynaMed Peer Review
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Education for Clinicians in Training

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