Anticoagulants safety checklist: caring for patients on oral anticoagulants

Use this checklist to prompt a discussion with your patients to achieve safe use and monitoring of oral anticoagulants.

This tool is not for recording patient information.

Document any issues identified in the patient’s record as part of your usual practice.


1. For all oral anticoagulants

Since the last visit, have there been any:

  • Signs of bleeding?

    Patients should be aware of and seek urgent help for signs or symptoms that might suggest bleeding.

    • epistaxis (nose bleeds)
    • gum bleeding
    • severe bruising
    • pink, dark or red urine
    • red or black faeces
    • other (e.g. rectal bleeding)
  • Signs of thromboembolic event? (e.g. stroke or deep vein thrombosis)
    Patients should be aware of and seek urgent help for signs and symptoms that might suggest stroke, or blood clots.
  • New or ongoing adverse effects identified? (e.g. dyspepsia/indigestion with dabigatran)
  • Changes in weekly alcohol intake?
  • Changes in cognition?
  • Missed doses?
  • New medicines started or stopped?
    (including herbal, over-the-counter medicines or vitamin supplements)

2. For warfarin

  • Is the most recent INR within target range?

In addition to missed doses and new medicines started or stopped:

  • Any factors that may influence INR stability?

    • nausea
    • vomiting
    • diarrhoea
    • flu-like symptoms
    • irregular eating/dieting
    • travel
    • changes in weekly intake of vitamin-K-containing foods

3. For dabigatran, rivaroxaban or apixaban

  • Any decline in renal function?
  • Does the patient have an existing concurrent illness (e.g. nausea, vomiting or flu-like symptoms) that may cause dehydration and affect renal function?
  • Is the patient using any concurrent medicines which may affect renal function? (e.g. diuretics, NSAIDS or ACE inhibitors)

Better manage oral anticoagulant therapy

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