Teaching About Anticoagulant Therapy (Home Health Care) - CE/NCPD

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The intended learners for this teaching skill are the patient and caregivers.

ALERT

When looking for medication interactions with anticoagulants, include all over-the-counter (OTC), herbal, supplemental, alternative, and complementary medications. Include regularly used intermittent and as-needed medications.^{undefined#ref3">3}

If bleeding cannot be stopped, continue to apply pressure to the injury and contact emergency medical services.

OVERVIEW

Anticoagulant therapy is used to manage and reduce the incidence of venous thromboembolism (VTE), pulmonary embolism (PE), and stroke in patients with atrial fibrillation (AFib), and for short-term therapy for some postoperative patients.⁴ The use of anticoagulant therapy can be complex, with benefits such as reduced risk for thrombus extension, stroke, or fatal PE, that usually outweigh the risk for life-threatening bleeding complications.⁴

Vitamin K antagonists, such as warfarin, unfractionated heparin, and low-molecular-weight heparin (LMWH) are recommended for patients with mechanical heart valves and valvular AFib and can be started and managed in an outpatient setting. Direct oral anticoagulants are recommended for treatment of non–cancer-associated VTE, whereas LMWH is recommended for cancer-associated VTE. LMWH is given by subcutaneous injection and does not require laboratory monitoring. Oral vitamin K antagonists require monitoring for a targeted international normalized ratio (INR).

Oral factor Xa inhibitors, such as rivaroxaban, apixaban, and others, are approved for prevention of strokes in patients with nonvalvular AFib, postoperative thromboprophylaxis with knee and hip replacement surgery, and treatment of deep vein thrombosis (DVT) and PE.¹ The advantages of Xa inhibitors are their efficacy in preventing stroke, a lower incidence of bleeding, fewer medication and food interactions, and no requirements for laboratory monitoring. These benefits make it a more favorable choice with practitioners for home care patients.

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.

STRATEGIES

1. Determine if the patient or family has health literacy needs or require tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
2. Review the patient’s and family's previous experience and knowledge of anticoagulant use and understanding of the care to be provided.
3. Discuss the prescribed anticoagulant therapy with the learner: its purpose; intended effects; requirements for monitoring, if needed; and side effects.
4. If the patient is taking warfarin for anticoagulant therapy, review the schedule for checking INR levels.
5. Discuss potential interactions with medications taken with anticoagulant therapy (Table 1).
6. Discuss complications that may happen with anticoagulant therapy (e.g., bleeding, bruising, hematoma at the injection site when using LMWH, skin necrosis when using warfarin).
7. Review strategies to treat or prevent complications.
   1. Use a soft-bristle toothbrush.
   2. Use an electric razor instead of a blade to limit the risk of cuts.
   3. Use caution with knives and tools.
   4. Pad sharp corners of furniture.
   5. Use caution with contact sports.
8. Discuss dietary recommendations.

   Rationale: A diet that includes food high in vitamin K (e.g., green leafy vegetables, kale, Swiss chard, collard greens, spinach, beef liver) may decrease the INR of a patient on warfarin. There is no need to cut out favorite foods, but the patient should not increase intake of vitamin K–rich foods.

9. Review herbal supplements, such as St. John’s wort, which may decrease the effectiveness of the anticoagulant medication.¹
10. Review herbal therapies that may increase bleeding risks (e.g., glucosamine – chondroitin, garlic, ginkgo biloba, dong quai).^1,2
11. Plan with the learner strategies for safety to avoid falls.
    1. Remove scatter rugs.
    2. Place nonskid bathmats in the bathroom and install handrails, when possible.
    3. Use skid-proof slippers indoors and shoes outdoors.
    4. Be mindful of pets underfoot.
    5. Use handrails when going up and down stairs.
12. Review with the learner strategies for when a bleed happens.
    1. Hold pressure to a bleeding wound for several minutes, giving enough time for clotting to happen.
    2. Review indications for calling for emergency assistance if bleeding cannot be controlled or stopped and the patient experiences lightheadedness or nausea.
13. Remind the learner of the importance that all health care providers are aware of the anticoagulant therapy, especially before any treatment, procedure, or surgery.

EXPECTED OUTCOMES

• The learner demonstrates understanding of education provided.
• The learner verbalizes understanding of bleeding precautions.
• The learner demonstrates understanding of monitoring requirements, if indicated, and dietary requirements when treated with anticoagulant therapy.

UNEXPECTED OUTCOMES

• The learner can’t demonstrate understanding of education provided.
• The learner can’t verbalize understanding of bleeding precautions.
• The learner can’t demonstrate understanding of monitoring requirements, if indicated, and dietary requirements when treated with anticoagulant therapy.

DOCUMENTATION

• Teaching methods and learning identified

REFERENCES

1. Lilley, L.L., Rainforth Collins, S., Snyder, J.S. (2023). Chapter 26: Coagulation modifier drugs. In Pharmacology and the nursing process (10th ed., pp. 405-429). St. Louis: Elsevier.
2. National Center for Complementary and Integrative Health. (NCCIH). (2023). Glucosamine and chondroitin for osteoarthritis: What you need to know. Retrieved April 7, 2025, from https://www.nccih.nih.gov/health/glucosamine-and-chondroitin-for-osteoarthritis-what-you-need-to-know
3. National Center for Complementary and Integrative Health. (NCCIH). (2025). Know the science: How medications and supplements can interact. Retrieved April 7, 2025, from https://www.nccih.nih.gov/health/know-science/how-medications-and-supplements-can-interact/some-supplements-may-increase-the-effects-and-side-effects-of-medications
4. Witt, D.M. and others. (2018, reviewed 2022). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Optimal management of anticoagulant therapy. Blood Advances, 2(22), 3257-3291. doi:10.1182/bloodadvances.2018024893

ADDITIONAL READINGS

National Institute for Occupational Safety and Health (NIOSH). (2024). NIOSH list of hazardous drugs in healthcare settings, 2024. Retrieved April 7, 2025, from https://www.cdc.gov/niosh/docs/2025-103/default.html

Clinical Review: Marlene L. Bokholdt, MS, RN, CPEN, TCRN

Published: May 2025