Download Key Elements in Warfarin Patient Education

Key Patient Education Elements to Cover at Baseline – Warfarin Therapy1
Rationale for therapy
How warfarin works to benefit the patient
Dosing and administration (timing)
Importance of adherence with dosing instructions and timely follow up
What to do about missed doses
Tablet identification/strength
Identification of generic and brand name
Visual recognition of drug/tablet strength
Potential drug interaction/RX/OTC/herbals
Avoidance of aspirin/NSAIDS
Activities/fall prevention
Dietary considerations – including alcohol use
Importance of regular laboratory and clinic monitoring (INRs, CBC, FOB ect)
Signs of over-anticoagulation
Signs of disease recurrence
What to do in case of bleeding
Interruption in therapy due to surgery or dental work
Keeping a log of INR results and medications
Informing other healthcare professionals
Women of child-bearing potential/safety in pregnancy
Warfarin identification card/bracelet
Emergency phone numbers and names
Refill procedures
Planning for trips
Safe storage from children and pets.
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Adapted from Ansell, Oertel, Wittkowsky Managing Oral Anticoagulation Therapy, Third Edition, 7:3
Major Points to Cover During Warfarin Patient Education2
General Patient Education
 Reason for Use: Avoid a thromboembolic event or prevent a recurrence of an
event
 How it works
 What is a PT/INR? What does it mean?
 Duration of therapy: short term vs. long term.
 Frequency of visits and blood testing
 Importance of compliance with follow up visits
 Notify all health professionals that you are on warfarin
 Inform anticoagulation provider prior to any scheduled surgeries or dental
procedures.
 Fall precautions, physical activity
 Side effects of warfarin: minor bleeding, skin rash, loss of hair
Medications
 Name of drug: brand and generic
 How much to take: color, strength, number of tablets
 Procedure for obtaining refills – importance of not running out of medication
 Try to use only one pharmacy
 Potential for interaction with other medications
 Report all medication changes to the anticoagulation provider – including new
and discontinued medications
 Verify safety of new medication with anticoagulation provider and determine if
closer follow up is needed
Adherence
 Encourage compliance with warfarin Therapy
 Take warfarin at the same time in the evening
 Keep track and report missed doses to anticoagulation provider. Do not double
dose to make up for missed dose.
 Use a compliance method such as pill box, written dose instructions, medication
calendars ect.
Bleeding
 Signs and symptoms of bleeding; major and minor
 Bleeding severity: severe, sudden headache, melana, hematemesis ect
 Avoid risky behaviors
 What to do if bleeding occurs: call clinic vs go to ER
 Distinguish new problem from an old one (chronic nose bleeds, hemorrhoids)
Disease Management
 Signs of disease recurrence:
2
Adapted from Ansell, Oertel, Wittkowsky Managing Oral Anticoagulation Therapy, Third Edition,7:4-7:5
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 PE: sudden shortness of breath and chest pain
 DVT: swelling, pain, heat, numbness in extremity
 CVA: numbness, tingling, sudden loss or change in speech, loss of
consciousness, falls, sudden vertigo, facial droop, sudden weakness in a
limb, visual changes or loss of sight in either eye
Importance of knowing what is baseline and what is new.
Diet
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Education on which foods are high in vitamin K
Understanding of why vitamin K alters therapy
Consistancy of high vitamin K containing foods
Avoidance of crash diets
Report problems with loss of appetite
Other Factors Altering Therapy
 Importance of reporting to anticoagulation provider any changes:
 Acute illness: flu bacterial/viral illness
 Diarrhea
 Nausea/vomiting
 Fever
 Congestive heart failure
Alcohol Use
 Do not encourage alcohol consumption
 Set a drinking limit per day
 Binge drinking: sudden increase in INR
 Long standing history of alcohol use/abuse: increase in liver enzymes may
require higher doses in warfarin
 Increased risk of GI bleeding
 Increase risk of injury causing serious bleeding
Pregnancy
 Do not become pregnant while on warfarin
 Use of birth control
 Explain risk of fetal harm
 Inform anticoagulation provider if you think you may be pregnant or are planning
to get pregnant.