Patient education about anticoagulant therapy

Prescribers should provide education for a patient prescribed anticoagulant therapy, discuss the reasons for taking anticoagulant therapy (including its expected benefits and potential harms) and emphasise the importance of regular clinical review by the patient’s general practitioner.

Advise the patient to carry an alert card or use MedicAlert so that healthcare professionals are aware the patient is being treated with an anticoagulant.

Supply and maintain a comprehensive list of the patient’s current medications. Anticoagulants are high-risk medicines; a home medicines review can minimise individual risk.

Inform patients verbally and in writing that some prescribed, over-the-counter, or complementary and alternative medicine products can be unsafe if combined with anticoagulants. Two common examples are nonsteroidal anti-inflammatory drugs (NSAIDs), which can increase the patient’s gastrointestinal bleeding risk, and St John’s wort, which can reduce the anticoagulant effect of direct-acting oral anticoagulants (DOACs) and warfarin.

Provide written information to all patients prescribed anticoagulants. For information about DOACs for health professionals and for patients (including patient information in languages other than English) see the New South Wales Clinical Excellence Commission website. For patients taking warfarin, information should include the intended target international normalised ratio (INR), the frequency of blood tests and the intended duration of therapy. See the Government of Western Australia Department of Health website for their Living with warfarin: information for patients.

Figure 1. Education for a patient prescribed an anticoagulant

Education for a patient taking an anticoagulant should include information about [NB1]:

  • indication—what the drug is for
  • dosing—when to take the dose, importance of not missing doses, action to take if a dose is missed or duplicated, importance of not switching brands of warfarin
  • adverse effects—common adverse effects, when and what symptoms need reporting to the GP
  • duration—expected duration of therapy, including planned timing of changes in therapy (eg treatment of venous thromboembolism)
  • monitoring—timing of and reason for blood testing (eg checking INR, checking kidney function)
  • bleeding risk—as it applies to the individual patient (eg if at risk of falling, if a prior bleeding episode has occurred), signs of bleeding to look for, action to take if bleeding occurs
  • concurrent medications—make other health professionals aware of the anticoagulant therapy, consider possible interactions with prescribed, over-the-counter, complementary and alternative medication
  • dietary requirements—when to take the anticoagulant in relation to food, advice on food that should be avoided or eaten in constant amounts
  • when to seek medical attention—trauma (eg head strike), significant bleeding
  • when to seek specialist advice—if planning pregnancy or pregnant (usually only UFH or LMWH is appropriate), or breastfeeding (either UFH, LMWH or warfarin are safe to use, but not DOACs)

DOAC = direct-acting oral anticoagulant; GP = general practitioner; INR = international normalised ratio; LMWH = low molecular weight heparin; UFH = unfractionated heparin

Note:

NB1: This list is suggestive, not exhaustive.