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<em>Decision-IQ</em>: Are Your Patients at Risk of Bleeding? Managing Thrombocytopenia in Chronic Liver Disease
Decision-IQ Decision-IQ

Decision-IQ: Are Your Patients at Risk of Bleeding? Managing Thrombocytopenia in Chronic Liver Disease


Maximum Credits:

By clicking "Continue," you confirm that you have reviewed the CME information.

Decision-IQ Decision-IQ
By clicking "Continue," you confirm that you have reviewed the CME information.


Maximum Credits:
Decision-IQ Decision-IQ
By clicking "Continue," you confirm that you have reviewed the CME information.


Maximum Credits:


In this case-based activity, meet 2 patients with chronic liver disease and thrombocytopenia who are scheduled to undergo invasive procedures. As you move through this activity, you will:

  • Be directed to useful resources to help you make management decisions for these patients
  • See how your answers compare with your peers’
  • Receive insights from gastroenterologists Steven Flamm, MD, and Nezam Afdhal, MD, on appropriate management for these patients

CME Information:

Nezam H. Afdhal, MD
Professor of Medicine
Harvard Medical School
Chief of Gastroenterology
Beth Israel Deaconess Medical Center
Boston, MA

Steven L. Flamm, MD
Professor of Medicine and Surgery
Feinberg School of Medicine
Northwestern University
Chicago, IL 
Activity Planners
Christie Avraamides, PhD
Clinical Content Manager
Baltimore, MD

Laura Rafferty, ELS
Managing Editor
Baltimore, MD

Samantha Gordon
CME Specialist
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM
Senior Manager, Accreditation and Compliance
East Lansing, MI 
Learning Objective
Upon completion, participants should be able to:

  • Individualize treatment for patients with CLD and thrombocytopenia according to bleeding risk, platelet count, coagulopathy status, and procedure type

Target Audience
This activity is intended for hepatologists, liver specialists, and gastroenterologists. 
Statement of Need
Thrombocytopenia occurs in approximately 64% to 84% of patients with cirrhosis or liver fibrosis and is associated with poor patient outcomes and increased mortality. Thrombocytopenia often delays or prevents patients from undergoing invasive diagnostic or therapeutic procedures because of the increased risk of bleeding. The treatment of thrombocytopenia is challenging for physicians as no guidelines exist on the minimum platelet count for which to apply prophylactic strategies to increase platelet numbers. In addition, data are limited in the literature regarding the optimal platelet count thresholds for specific procedures. Management strategies for thrombocytopenia have traditionally included platelet transfusions; however, this approach is associated with safety concerns. In 2018, two new thrombopoietin receptor agonists were approved by the United States Food and Drug Administration for the treatment of thrombocytopenia in patients with CLD who are scheduled to undergo procedures. Hepatologists, liver specialists, and gastroenterologists need to be up-to-date on recommended treatment approaches in order to optimize the management of thrombocytopenia and minimize bleeding risk in CLD patients who are undergoing scheduled procedures.  

Providership Statement
Provided by Med-IQ. 
Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Med-IQ designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse practitioners, physician assistants, and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available. 
Medium/Method of Participation
This CME activity consists of a 0.5-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly. 
Initial Release Date: February 13, 2020
Expiration Date: February 12, 2021
Estimated Time to Complete This Activity: 30 minutes

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation. 
Nezam H. Afdhal, MD
Salary: Spring Bank Pharmaceuticals
Consulting fees/advisory boards: Gilead Sciences, Inc., Ligand Pharmaceuticals, Shionogi
Ownership interest (stocks/stock options – excluding mutual funds): Allurion Technologies, Spring Bank Pharmaceuticals

Steven L. Flamm, MD
Consulting fees/advisory boards: Dova Pharmaceuticals, Shionogi 
The peer reviewers and activity planners have no financial relationships to disclose.
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.
Contact Information        
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

System Requirements



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    • Apple (eg, iPhone/iPad)
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    • Android (Chrome)
    • Apple (Safari)

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Acknowledgement of Commercial Support
This activity is supported by an educational grant from Shionogi. 
© 2020 Med-IQ, Inc.


Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

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