Table 3.1-3. Education of patients treated with VKAs (or their caregivers)

– Explain reasons for using the anticoagulant treatment

– List all generic and trade names of the used anticoagulant(s) 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 the INR

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

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

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

– Describe how to avoid injuries and bleeding

– Describe the most common symptoms and management in case of deep vein thrombosis 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 the 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 the use of VKAs

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

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

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

Adapted from Ann Pharmacother. 2008;42(7):979-88.

INR, international normalized ratio; VKA, vitamin K antagonist.