– Explain reasons for using the anticoagulant treatment.

– List all generic and trade names of the used anticoagulants and discuss how they reduce the risk of thrombosis and its complications.

– Explain the expected duration of treatment.

– Explain why it is necessary to determine INR.

– Explain the target INR values recommended for the patient and the narrow therapeutic range.

– Emphasize the need for frequent and regular INR determination to reduce the risk of bleeding or thrombosis. Inform the patient about the possibility of self-monitoring of INR in capillary blood using a portable coagulometer (eg, CoaguCheck).

– Describe the most common symptoms of bleeding and appropriate management.

– Describe how to avoid injuries and bleeding.

– Describe the most common symptoms and management in case of DVT or pulmonary embolism.

– Discuss the effect of foods containing vitamin K1 on the anticoagulant effect of VKAs (see table 3.1-2).

– Discuss the effects of taking certain drugs (both prescription and over-the-counter) on the anticoagulant effect of VKAs (see table 3.1-2) and management when switching drugs.

– Discuss the increased risk of bleeding associated with concomitant treatment with antiplatelet drugs.

– Discuss the need for limiting or refraining from alcohol consumption.

– In female patients likely to become pregnant, discuss the risks associated with using VKAs.

– Explain the reason and emphasize the need to inform doctors, dentists, and other medical professionals about VKA use.

– Explain at what time of day VKA should be taken and discuss what to do in case of a missed dose.

– Suggest that the patient carries relevant information concerning VKA use (eg, medical information cards together with an ID, a bracelet).

– Document discussing these topics with the patient and/or caregiver in the medical records.