ANTICOAGULATIONMANAGEMENTSERVICE

PATIENT AND FAMILY EDUCATIONPATIENT AND FAMILY EDUCATION

1

WHY DO YOU NEED WARFARIN(C ®)?(COUMADIN®)?

This is how a blood clot might look inside a blood

“blood thinner”To prevent or treat

g oo s e a oo vessel

To prevent or treat blood clots

Thrombus = Blood Clot

2

TOPICS WE WILL REVIEW

Information we discuss can be found in this oReason found in this

Guide for review at home

oReasonoWarfarin SafetyoBlood TestsoINR RangeoINR RangeoSide Effects

R filloRefills

3

HERE ARE COMMON REASONS WHYPEOPLE TAKE WARFARIN:

Heart Heart Problems Blood Clots Stroke

•Afib (atrial •Stroke•Legsb (at afibrillation)•Artificial heart valves

St o e•TIAs (transient ischemic attack)•Mini-strokes

•Legs•Lungs•Arms

valves•Heart attack

Mini strokes

The location of the clot gives 4

gclues to symptoms. See

details in Guide & Handout

AA Anticoagulation

MMMMManagement

SS Service

Every patient has a primary nurse – your AMS nurse is your ‘warfarin manager’AMS nurse is your warfarin manager

AMS Office Hourso Monday – Friday: AMS nurse phone lines

answered 8 am – 4 pm W k d & H lid A AMS o Weekends & Holidays: An AMS nurse available for emergencies only

5

The AMS Team 6The AMS Team

WHAT IS YOUR PILL COLOR AND( )MILLIGRAM (MG) STRENGTH?

7

HOW DO YOU GET REFILLS?

Call the doctor who prescribes pwarfarin

Know your pill color and

Get our refill hen ou ha e a 2

Know your pill color and mg strength!

Get your refill when you have a 2 week pill supply remaining

8

THE INR IS THE NAME OF YOURBLOOD TEST

INR = International Normalized Ratio INR International Normalized RatioThe goal is to stay in a specified INR range

It i l t It is normal to vary

Yo r INR range i : to 9Your INR range is: ____ to _____

BLOOD TESTS ARE IMPORTANT SO WEKNOW HOW YOUR WARFARIN ISKNOW HOW YOUR WARFARIN ISWORKING

G bl d d h k d Get your blood test done when asked If you get a phone message, email or letter about

missing blood tests CALL the number givenmissing blood tests, CALL the number given

10

REMINDER CALLS FOR MISSINGBLOOD TESTS

If you missed your blood test date, we will remind y y ,you

Reminder phone calls are made when 2 days late d 6 around 6 pm

This is what the call says:E li hEnglish

11

REMINDER PHONE CALLS IN OTHERLANGUAGES

12

Spanish Arabic Cambodian Chinese-Mandarin

Chinese-Cantonese

RussianItalian Portuguese

HOW OFTEN DO YOU NEED BLOODTESTS?When you first start, testing is ofteny , gLater, it will be lessThere are many reasons you may be asked e e a e a y easo s you ay be as ed

to have your blood tested more oftenYou can use a lab located close to youUse this card at any MGH lab

13

BE AWARE OF FACTORS THATMIGHT CHANGE YOUR INR

Medications Being sick• prescription

Medications Being sick

• over‐the‐counter• Tylenol A i i• Aspirin

• minerals & herbals• Nausea, vomiting and/or diarrhea for more than 2 daysmore than 2 days

• Fever 

14

MORE FACTORS THAT MIGHT CHANGEYOUR INR

Diet Alcohol

1 drink =  12 oz. beeror 5 oz. wineor 1.5 oz. liquoror 1.5 oz. liquor

Consistency is best!  15

WHAT IF YOU MISS A DOSE?

Take your regular d H l f l Hi tdose as soon as possible if you remember before Take at same time daily

Helpful Hints:

remember before midnight

Never double your

Use pill box

ydose

Call your AMS nurse about any missed doses

16

HOW DO YOU KNOW HOW MUCHWARFARIN TO TAKE?

We send you a letter or email after each We send you a letter or email after each INR

Read the letter or email carefully for any y ychanges

If you do not receive the letter within 4 ydays or email 1 day after a blood test, call your AMS nurse

If you need a dose change right away, we will call you

17

DOSE INSTRUCTION LETTER

18

DOSE INSTRUCTION LETTERWITH SKIP MESSAGE

19

BLEEDING IS A POSSIBLE SIDE EFFECT

Minor Requires medical attention

20

WHEN TO CALL 911---DANGER SIGNS---

Chest pain, discomfort in arms, back, neck, or jaw Trouble breathing Severe headache, confusion or numbness Sudden vision changes Sudden vision changes Stroke signs:

Fall or injury to your head Throwing up blood (might be bright red or looks like

coffee grounds)coffee grounds) Bleeding you cannot stop

21

SAFETY TIPS

Avoid injuryj y• Carry anticoagulant wallet card• Wear proper safety gear

22

PREVENT FALLS

Remove hazardsRemove hazards Clear clutter from

stairs Remove scatter

rugsUse safety devices

Walkers, canes, t i ilstair rails

Improve lighting Night lights Night lights 23

YOU MAY NEED TO STOP YOURWARFARIN A FEW DAYS BEFOREWARFARIN A FEW DAYS BEFORECERTAIN PROCEDURES

The doctor who prescribes your warfarinshould be the one to provide instructions

Call your AMS nurse about:Call your AMS nurse about: Colonoscopy Dental surgeryg y Heart procedures Steroid injection Surgery

24

TIPS FOR TRAVELING

Tell your AMS nurse: Tell your AMS nurse: Dates you plan to be away How we can contact youy

Carry medicines with youDo NOT place medicines in p

checked luggage

Call your AMS nurse if your telephone or address change

25te ep o e o add ess c a ge

PREGNANCY / BREASTFEEDING

If pregnant, you should If pregnant, you should NOT take warfarin

Use appropriate form of birth control

Talk with your doctor to k l f make plans for pregnancy

or breastfeeding

26

LET’S REVIEW:

Why are you taking warfarin? What is your INR range? What is the strength and color of your

f i ill?warfarin pill? What are some factors that affect the INR? Who refills your prescription? Who refills your prescription? What symptoms require medical attention?

Call your AMS nurse with ANY 27questions about your wafarin safety

AMS wants you to be actively i l d ith involved with your care

28

THE PATIENT AND FAMILY EDUCATION PROGRAMREVISED BY:Rachel Corneau, RNRachel Corneau, RNNathalie Grebert, RNPalmie Riposa, RN Jamie Ronin, RN (CNS Graduate Student, U Mass)L O t l MS RN CNSLynn Oertel, MS, RN, CNS

ANTICOAGULATION MANAGEMENT SERVICEMassachusetts General HospitalProfessional Office Building – Suite 101275 Cambridge StreetBoston, MA 02114617-726-2768mghams@partners.org

29

Version: June 2014