Addressing GI Bleeds and Mitigating Risks: Focus on DOAC Reversal and Unanswered Questions

Addressing GI Bleeds and Mitigating Risks: Focus on DOAC Reversal and Unanswered Questions

On-Demand Webcast

Sunguk Jang, MD
Cleveland Clinic
Cleveland, Ohio


Noam Z. Drazin, MD
Los Angeles, California

Yen-Te Christian Tu, MD
Houston Methodist
Houston, Texas

Target Audience

This activity is designed for gastroenterology physicians, fellows, and related healthcare providers.


Direct oral-acting anticoagulants (DOACs) are beginning to supplant traditional anticoagulation agents as preferred agents for thromboembolic management. However, evidence shows that they may carry some risk of major GI bleeding. The treatment of patients with major GI bleeding is extremely challenging, even more so for patients on DOACs due to a limited evidence base for effective risk assessment and real-world reversal strategies, a lack of evidence-based guidance concerning the management of acute GI bleeding in patients on DOACs, a lack of consensus among GI clinicians regarding best-practice management of patients in need of DOAC reversal, and poor team-based multidisciplinary management skills and practices.

This webcast provides expert guidance on identifying risk factors for severe GI bleeding, addressing anticoagulation management for patients with acute GI bleeding, and integrating DOAC reversal strategies into treatment plans.


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

  • Identify risk factors for severe GI bleeding among patients on DOACs
  • Review current guidance addressing anticoagulation management for patients with acute GI bleeding
  • Discuss strategies to balance life-threatening bleeting and thrombosis risk in patients with severe GI bleeding
  • Integrate tools for cross-disciplinary communication and coordination into real-world treatment plans for patients with severe GI bleeding

Release Date: November 30, 2019

Expiration Date: November 30, 2020

Hardware/Software Requirements

The evaluation is accessible after the activity via a PC (Windows 7 or newer) or Mac (Mac OS 10.6 or later) computer with current versions of the following browsers: Internet Explorer, Mozilla Firefox, Google Chrome, or Safari. A PDF reader is required for print publications. Please direct technical questions to


Supported by educational grant from: Portola Pharmaceuticals, Inc.


 In support of improving patient care, this activity has been planned and implemented by North American Center for Continuing Medical Education (NACCME) and Imedex. NACCME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


NACCME designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.


NACCME has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with the AAPA CME Criteria. This activity is designated for 1.00 AAPA Category 1 credit(s).

PAs should only claim credit commensurate with the extent of their participation.


This continuing nursing education activity awards 1.00 contact hour.

Provider approved by the California Board of Registered Nursing, Provider #13255 for 1.00 contact hour.


This knowledge-based activity (JA0006201-9999-20-026-H01-P) is approved for 1.00 contact hour (0.1 CEU) of continuing pharmacy education.

ACPE Credit Policy

Your official record of ACPE credit will be generated through the CPE Monitor System. The certificate printed from this website after completing the evaluation for this activity is for personal tracking purposes only.

Eligibility for pharmacy credit is contingent upon the successful completion of a post-test and/or evaluation for each activity or session attended. Please note that you must complete the activity evaluation within 60 days of a live activity or within 60 days of beginning the evaluation for an enduring activity. Under ACPE Policy, NACCME will not be able to report your activity completion to CPE Monitor after this 60-day period.

Any participant wanting to file a grievance with respect to any aspect of a continuing pharmacy education activity accredited by NACCME may contact the Manager, Accreditation & Compliance, NACCME, in writing at 104 Windsor Center Drive, East Windsor, NJ 08520. The Manager, Accreditation & Compliance will review the grievance and respond within 30 days of receiving the written statement. If the participant is unsatisfied with the response, an appeal to the Senior Director, Accreditation and Compliance, NACCME, may be made for a second level of review.

Planning Committee

The planning committee comprises Sunguk Jang, MD, Noam Z. Drazin, MD, Yen-Te Christian Tu, MD; and Chris Bolwell, and Manjusha Sala, Imedex.

Financial Disclosure and Conflicts of Interest

According to the disclosure policy of NACCME and Imedex, faculty, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant financial relationships with relevant commercial companies related to this activity. All relevant financial relationships that are identified are reviewed for potential conflicts of interest. If a conflict is identified, it is the responsibility of NACCME and Imedex to initiate a mechanism to resolve any conflicts. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation.

All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

Noam Z. Drazin, MD, reports that he has financial relationships with commercial interests in Amgen, Eli Lilly, BMS, and AstraZeneca.

Sunguk Jang, MD, reports that he has nothing to disclose in relation to this activity.

Yen-Te Christian Tu, MD, reports that she has nothing to disclose in relation to this activity.

Chris Bolwell discloses that he holds shares of stock of GlaxoSmithKline.

Manjusha Sala disclosed no relevant financial relationships with any commercial interests.


This activity may contain information about experimental and other uses of drugs or devices that are not currently approved by the European Medicines Agency (EMA) of the European Union or the Food and Drug Administration (FDA) of the United States. Participants are strongly encouraged to consult approved product labeling for any drug or device mentioned in this activity before use. The opinions expressed during this activity are the opinions of the respective authors, presenters or moderators and do not necessarily reflect the opinions of NACCME or Imedex.

Privacy Policy

NACCME and Imedex protect the privacy of personal and other information regarding participants, educational partners, and joint providers. NACCME, Imedex and our joint providers will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

NACCME and Imedex maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Copyright © 2019 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education. The opinions expressed in this educational activity are those of the faculty and are not attributable to NACCME. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this activity are not necessarily the same as indicated in the package insert for each product, may reflect the clinical experience of the presenters, and may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.