Question

Patient Teaching: Anticoagulants

Sandra is a 27-year-old female admitted with a possible Deep Vein Thrombosis (DVT). She smokes one pack per day and is on birth control. She has a history of hypertension and obesity. She is admitted to the hospital and placed on bedrest. Heparin drip is started per protocol. The Provider is anticipating on sending her home with Coumadin.

Can Sandra be placed on Coumadin and Heparin at the same time? Explain your answer.

Develop 3 teaching points important for Sandra to know about her medications regimen.

Teach Back is a great way to find out about patient teaching effectiveness. Watch the following video for an example of Teach Back

What questions would you ask Sandra to verify that she understand the 3 teaching points?

Answer 1

Can Sandra be placed on Coumadin and Heparin at the same time?

• Oral anticoagulants can be started at the same time on the first day of heparin therapy and should be continued for at least three to six months, depending on the individual.
• The optimal duration of intravenous heparin treatment is five to seven days because this is the time needed to obtain an adequate and persistent reduction in the vitamin K dependent clotting factors with oral anticoagulants such as coumadin (warfarin).
• Warfarin usually takes a couple of days to reach the correct level, so the heparin is needed to help treat the clot while the warfarin starts to act.
• Heparin can then be stopped when concomitant use with warfarin has achieved an international normalised ratio (INR) of 2-3 for at least 48 hours.

Patient teaching

1. Warfarin should be taken exactly as directed -

Do not increase, decrease, or change the dose unless told to do so by a healthcare provider. If a dose is missed or forgotten, call the prescribing clinician for advice. Don’t start new medications, herbals, or supplements without talking to your healthcare provider.

2. Warfarin Interacts With Alcohol and With Certain Foods -

?Patients undergoing warfarin therapy should avoid drinking alcohol on a daily basis.The antiplatelet effect of alcohol increases the risk of major bleeding, even if the INR remains within the target range.

Eating an increased amount of foods rich in vitamin K can lower the PT and INR, making warfarin less effective and potentially increasing the risk of blood clots. Patients who take warfarin should aim to eat a relatively similar amount of vitamin K each week. The highest amount of vitamin K is found in green and leafy vegetables such as broccoli, lettuce, and spinach.

3. Reduce the risk of bleeding

There is a tendency to bleed more easily than usual while taking warfarin. simple precautions can avoid risk of bleeding such as -

• Do tell anyone giving you medical or dental care that you are taking warfarin.
• Shaving with an electric razor rather than a razor blade, being careful when using knives or sharp objects, and avoiding certain contact sports with a high risk of injury.
• Always use a seatbelt, Wear a helmet when riding a bicycle or motorcycle.

Teach back questions

1. Tell me what you should do if you miss a dose of warfarin?
2. What food should be avoided during warfarin therapy?
3. Why precautions should be taken to avoid risk of injury?