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This activity is jointly provided by The University of Tennessee College of Pharmacy, and Catalyst Medical Education, LLC.
This activity is supported by an educational grant from the Bristol-Myers Squibb and Pfizer Alliance.


This activity will evaluate the use of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) who are obese. Expert faculty will examine the limited clinical trial data on the effect of obesity or extreme obesity on DOAC dosing and how data from retrospective observational studies may be used to supplement evidence from randomized controlled trials.Case studies will offer opportunities to apply this information in virtual patient scenarios and facilitate implementation into real-world pharmacy practice.


This initiative is intended for all pharmacists who participate in the management and care of patients with atrial fibrillation (AF).


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

  • Discuss the pharmacokinetics and pharmacodynamics of the US Food and Drug Administration-approved dosing for apixaban, rivaroxaban, endoxaban, and dabigatran as it relates to body weight and obesity
  • Discuss the available efficacy and safety data from randomized controlled trials on DOACs vs warfarin in patients with AF and obesity or extreme obesity, including the limitations of such data to inform clinical practice
  • Evaluate findings from retrospective observational studies that assess DOAC efficacy and safety vs one another and vs warfarin in patients with AF and obesity or extreme obesity, and how these studies help address gaps in data
  • Assess the potential clinical implications of accumulating evidence on the use of DOACs in patients with AF who are obese and extremely obese, that were not considered when formulating current guideline recommendations
  • Utilize the latest comprehensive evidence to develop and support appropriate and effective treatment decision-making that considers DOACs vs warfarin for patients with AF and obesity or extreme obesity


John H. Alexander, MD, MHS (Chairperson)
Professor of Medicine/Division of Cardiology
Duke Clinical Research Institute
Duke University School of Medicine
Durham, NC

Jeffrey B. Washam, PharmD, FAHA, BCPS (AQ-Cardiology)
Clinical Pharmacist
Duke Heart Center
Consulting Associate
Department of Medicine, Duke University
Durham, NC

Kathleen A. Lusk, PharmD, BCPS, BCCP
Associate Professor and Vice Chair, Department of Pharmacy Practice
University of the Incarnate Word Feik School of Pharmacy
Adjunct Assistant Professor, Division of Cardiology, Department of Medicine
UT Health San Antonio
Clinical Pharmacy Specialist
University Health System
San Antonio, TX


John H. Alexander, MD, MHS, has disclosed the following relevant financial relationships:

  • Research Support: Bayer, Bristol-Myers Squibb, CryoLife, CSL Behring, Ferring, Food and Drug Administration, Glaxosmithkline, Humacyte, National Institutes of Health, XaTek
  • Consultant/Honoraria: AbbVie, Akros, Atricure, Bristol-Myers Squibb, CryoLife, Ferring, Glaxosmithkline, Janssen, Pfizer, Portola, Veterans Administration 

Kathleen A. Lusk, PharmD, BCPS, BCCP, has no relevant financial relationships to disclose.

Jeffrey B. Washam, PharmD, FAHA, BCPS (AQ-Cardiology), has no relevant financial relationships to disclose.

All of the relevant financial relationships listed for these individuals have been mitigated

Type of Activity: Application-based
Fee Information: There is no fee for this educational activity

Release Date

November 16, 2021

Expiration Date

November 16, 2022


acpeThe University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this application-based activity will provide a statement for 1.5 home study contact hours credit (0.15 CEUs). Successfully completing the activity and receiving credit includes: 1) viewing the educational activity in its entirety; 2) successfully completing the post-test; 3) completing the educational activity evaluation form. UAN: 0064-9999-21-201-H01-P. It is recommended that you check your NABP CPE Monitor e-profile database 30 days after the completion of any CE activity to ensure that your credits are posted.

  • NABP e-PROFILE ID NUMBER: Pharmacists or pharmacy technicians with questions regarding their NABP e-Profile or CPE Monitor should refer to the FAQ section on the NABP website: http://www.nabp.net/programs/cpe-monitor/cpe-monitor-service.
  • To receive credit for your participation in this activity, all pharmacists must include their NABP e-Profile ID number, along with their date and month of birth. If incorrect information is provided, this will result in "rejected" status from the CPE Monitor. It is the responsibility of the participant to notify The University of Tennessee (within the 60 day submission timeframe) of their corrected information. Otherwise, the completed CE will not be accepted by the CPE Monitor.