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Presented by the Johns Hopkins School of Medicine.

OVERVIEW
Advances in understanding the pathophysiology of thrombocytopenia have led to the development of a new class of agent, thrombopoietin receptor agonists (TRAs), two of which were recently approved by the US Food and Drug Administration. These therapies have implications across a range of thrombocytopenias and disease states. TRAs overcome many limitations of the minimally effective conventional procedures used to manage patients with chronic liver disease who undergo elective surgical procedures. TRAs also have implications as first- and second-line treatment strategies in patients with chronic thrombocytopenia, specifically immune thrombocytopenia purpura (ITP), and is emerging as a treatment strategy for chemotherapy-induced thrombocytopenia. Appropriate use of these agents in practice requires that treating clinicians are both up-to-date on the latest evidence-based literature regarding TRAs as part of thrombocytopenia management and proficient in implementing these treatments appropriately. As a result, there is a need for education, specifically for hematologists and other healthcare professionals who treat patients with thrombocytopenia, that focuses on the efficacy and safety of novel treatments, the pathophysiology of hemostatic mechanisms affected in liver disease and other pathologies, bleeding risk laboratory measures used to guide treatment-making decisions, and navigating guideline recommendations for the appropriate diagnosis and treatment strategies for patients with thrombocytopenia.


GOAL
The goal of this activity is for hematology clinicians to be updated on the latest evidence on the clinical utility of thrombopoietin receptor agonists in the management of patients with thrombocytopenia of varying etiologies. It will also highlight strategies to apply newly learned evidence into clinical practice.

WHO SHOULD ATTEND
This activity is intended for hematologists, nurse practitioners, physician assistants, and nurses who treat and manage patients with thrombocytopenia associated with various etiologies. No prerequisites required.

EDUCATIONAL OBJECTIVES
After participating in this activity, the learner will demonstrate the ability to:
  • DESCRIBE hemostatic pathological processes contributing to bleeding/thrombosis in liver disease and available laboratory measures to assess coagulation.
  • EVALUATE the role efficacy and safety of second-generation recently approved TRAs in the management of thrombocytopenia in adults with chronic liver disease.
  • IDENTIFY strengths of currently approved TRAs and develop strategies to select a TRA based on patient and procedural factors.
  • ASSESS the potential of TRAs in the management of chronic immune thrombocytopenia, chemotherapy-induced thrombocytopenia, and severe aplastic anemia.
The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

ACCREDITATION STATEMENT
accme_logoThe Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this enduring material internet activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

POLICY ON PRESENTER AND PROVIDER DISCLOSURE
It is the policy of the Johns Hopkins School of Medicine that the presenter and provider globally disclose conflicts of interest. The Johns Hopkins School of Medicine OCME has established policies that will identify and resolve conflicts of interest prior to this educational activity. Detailed disclosure will be made prior to presentation of the education.

PARTICIPATING FACULTY
Satish Shanbhag, MBBS, MPH, FACP (Chair)
Associate Professor of Medicine and Oncology
Johns Hopkins School of Medicine
Baltimore, MD

James B. Bussel, MD
Emeritus Professor of Pediatrics
Medicine and Obstetrics and Gynecology
Weill Cornell Medicine
New York, NY

Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME.

The following relationships have been reported for this activity:
James B. Bussel, MD, reports receiving a consulting fee for serving on an advisory board for Amgen, Inc., Novartis AG, and Rigel Pharmaceuticals, Inc.; receiving a consulting fee for serving on an advisory board and as a consultant for Momenta Pharmaceuticals, Inc., and UCB, Inc.; receiving honoraria from Novartis AG; and for serving on the Data Safety Monitoring Board for CSL Behring.

Satish Shanbhag, MBBS, MPH, FACP, reports performing contracted research as a co-principal investigator for Daiichi Sankyo Company Ltd and receiving consulting fees from GlaxoSmithKline and Takeda Pharmaceutical Company Limited.

No one else in a position to control the content of this educational activity has disclosed a relevant financial interest or relationship with any commercial interest.


Note: Grants to investigators at the Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

Release Date: May 4, 2020   Expiration Date: May 4, 2021

DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.


COPYRIGHT
All rights reserved - The Johns Hopkins University School of Medicine. No part of this program may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.


Confidentiality Disclaimer for CME Activity Participant
I certify that I am participating in this Johns Hopkins School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am participating in this capacity, I may be exposed to “protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-614-9900, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office at 410-955-2959 or e-mail cmenet@jhmi.edu.
Johns Hopkins School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03) (Updated 4/09 and 3/14)

HARDWARE & SOFTWARE REQUIREMENTS
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

ACTIVITY INSTRUCTIONS
The following is a video-based expert panel designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited preassessment, the video-based activity, and a CE post-assessment and evaluation. All 3 sections must be completed to receive CE credit. A certificate of participation will be available online immediately following successful completion of the activity.

TABLE OF CONTENTS
Preassessment

Advances in Thrombocytopenia Management During Elective Procedures in Liver Disease

Anticipating Bleed Risk to Inform Treatment Decision-Making: Appropriately Utilizing Available Laboratory Measures

Thrombopoietin Receptor Agonists: Mechanism of Action and Rationale for Use

Update on Thrombocytopenia: Immune Thrombocytopenia, Severe Aplastic Anemia, and Chemotherapy-induced Thrombocytopenia

Applying TRAs to Practice: Clinical Pearls for the Hematologist

Postassessment and Evaluation

FEE INFORMATION
There is no fee for this educational activity.

This activity was developed in collaboration with ASiM.


procced to pretest




Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by ASiM CE, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2017 by ASiM CE, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of ASiM CE LLC.