ADC TROMBOSEDIENST. Quality. The mission. The vision. The functioning of the ADC Thrombosis Service

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Posy Cooper
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1 ADC TROMBOSEDIENST Quality The mission The vision The functioning of the ADC Thrombosis Service Which INR is good, for how long do I have to take anticoagulant? Intensity 1 or 2 Frequency of taking an INR Thrombosis and embolism Influence of other medications on your anticoagulant medication Vitamin K Alcohol use Stress Accessibility ADC Thrombosis Service In 2004, the ADC Thrombosis Service opened its doors. The Thrombosis Service is responsible for start-up, monitoring and guiding outpatients under oral anticoagulant treatment with Acenocoumarol or phenprocoumon (Marcoumar ). This means that the ADC Thrombosis Service is responsible for blood sampling, the analysis of the INR, the determination of the dose of the anticoagulants and, if necessary, the stop the treatment for examinations and interventions or in case of bleeding. From 1 January 2016, the ADC follows the FNT's internationally used therapeutic INR values. The range within which your INR is good has been reduced from 1 January These are for the 1st and for the 2nd intensity group. For more information: Quality To ensure quality, the ADC Thrombosis Service has been a member of the Federation of Dutch Thrombosis Services (FNT) since The FNT monitors the quality assurance in a coordinated manner. This quality assurance certificate gives the client / patient of the ADC thrombosis service the guarantee that it meets quality requirements and that there is a structure in which any bottlenecks can be identified and resolved early. To ensure that an organization continues to meet the requirements, it is periodically visited and assessed to determine whether the membership can be extended.

2 Through international research already proved that with a good institution of the INR there are fewer complications. The mission To optimize the service to the patient who has to take anticoagulation, by providing quality improvement, quality control and prevention through good information, continuity of care. The vision Responding to the field, a Thrombosis service is established to improve the care and well-being of patients who use anticoagulation. This by better overview on the duration of treatment, fewer complications and inform patients to achieve better therapy faithfulness. In short: the functioning of the ADC Thrombosis Service The attending physician signs the patient in by means of the Thrombosis registration form. The Thrombosis Service takes over the anticoagulant treatment for the attending physician. The attending physician remains responsible for the duration of the treatment. When registering, the TRD employee informs the patient during an intake interview. The patient is asked to inform the TRD of data that are important for the proper course of the anticoagulation treatment. For each blood sample, the patient completes a short questionnaire, if necessary assisted by the Laboratory nurse, this is called a mini-anamnesis. After each blood sample, the patient receives the next working day, via the CPost Elit a new dose calendar and a new date for the next blood sample. If the INR is not in good range or it s a new patient, the patient is called in the afternoon on the day of the blood sample with the new dose information. The bottom of the dose-calendar is also the application form for the next INR blood sample. Patient information leaflets are available in Papiamento, Dutch and English. The dosing consultants and dosing physicians maintain contact with the patients, the attending physicians, the general practitioners and other specialists if necessary. The TRD works with the Portavita software program, collects relevant patient data, processes it, doses and ensures that patients receive their new dose and dose calendar on time. Dosing consultants and dosing doctors regularly attend additional training.

3 The TRD provides information to colleagues, doctors and patients. The INR With the Prothrombin test (PT) test, we test how "thin" or "thick" the blood is. "Thick" and "thin" does not mean that the blood is viscous or watery. It means "clotting time", the time that the blood needs to solidify. The PT is expressed in INR, which is the international standardized expression for the PT. The specialist decides which range is best for you and whether your blood should be more or less "thin" or "thick". Intensity 1 or 2 Depending on the indication, the patient is classified in one of the two intensity groups determined by the Federation of Dutch Thrombosis Services. 1st intensity group: Therapeutic area: INR Atrial fibrillation, (prevention) venous thrombosis embolism, cerebrovascular insufficiency 2nd intensity group: Therapeutic area: INR (prevention) arterial thromboembolism, recurrent venous thromboembolism during anticoagulation treatment, tissue valve prosthesis, mechanical heart valve prosthesis. A recommended duration for treatment is associated with each indication. The attending physician can always deviate from this. o 3m 3 months o 6m 6 months o 1 jr 1 year o 1 jn after 1 year ask the attending physician if longer treatment is needed o L Lifetime Your attending physician has prescribed anticoagulant medications such as Acenocoumarol or Phenprocoumon. These are so-called vitamin K inhibitors. Your doctor has reviewed for you how long you should use this anticoagulant and therefore decides on the duration of your treatment, not the thrombosis service. How long your anticoagulant treatment lasts depends on your condition and / or medical situation. Some conditions require you to be treated for life with anticoagulant medications. This is the case, for example, if you have cardiac arrhythmia atrial fibrillation, have a mechanical artificial heart valve or have had thrombosis or pulmonary embolism more than once. In some conditions, you only need to temporarily use anticoagulant medications. For example, the first time having a thrombosis or pulmonary embolism. Your treatment usually lasts three to six months. If you have a hereditary predisposition to thrombosis, your doctor will see if and for how long your anticoagulant treatment should last. This is different per person. Take the INR at home Blood sample at home only takes place at the written request of the attending physician. The laboratory nurse must be able to enter the house safely, dogs must be leashed. If you are not at home on the appointment day, you must cancel at least 24 hours in advance. In case of noncancellation, you are responsible for coming to an ADC lab as soon as possible.

4 Frequency of INR blood sample Your thrombosis service will take your health situation into account when dosing your tablets. Sometimes that situation is such that it is wise to (temporarily) adjust the number of pills that you have to take. We are striving to keep your INR value within your INR therapeutic range. This makes your chance of thrombosis or bleeding, as small as possible. It is therefore very important that you tell the member of the Thrombosis Service about changes in your health. This information is recorded in your file. The doctor of the Thrombosis Service will take these details into account when giving or approving a dosing advice and the next appointment day. If the INR is stable and there are no details, check will be between 4-6 weeks, depending on your indication and age. Thrombosis and embolism That our blood can clot is usually very useful. If you lose blood due to a wound, blood clotting will stop bleeding. But sometimes our blood coagulates without any bleeding. Doctors then speak of a thrombosis. Thrombosis is dangerous because it impedes blood flow. A clot can also come loose from the blood vessel wall and be carried along by the blood stream. Such a loose clot is called an embolism and can completely or partially close a blood vessel later in the bloodstream. This can lead to all kinds of serious illnesses, such as pulmonary embolism, cerebral infarction or myocardial infarction. Thrombosis is caused by blood clotting in your body at the wrong time and in the wrong place. There are 3 main causes of thrombosis, damage of the inner wall of the blood vessel, a slow blood flow and clotting disorders. Practice sport Usually it is quite possible to simply (continue to) exercise or exercise. In fact, exercise or exercise is often beneficial. It lowers your chance of a (new) thrombosis. How do you choose a good sport? The most important thing is to choose a sport that suits you and your daily life. For example, walking and swimming are great options. Furthermore, it is important to avoid martial arts, such as kickboxing, which is more likely to cause injuries and an increased risk of bleeding. Diving and deep-sea diving are not allowed. At a depth of 5 meters you have a risk of eye and ear bleeding. You can snorkel, to a depth of up to 3 meters. Influence of other medications Many medications can influence the effect of anticoagulant tablets. They can strengthen or counteract the effect. It is therefore very important that you always report your use of other medicines at your thrombosis service and Botica (pharmacy). The same applies if you buy over the counter medication, herbs, vitamins, etc. or stop taking medicines. Also carefully read the package leaflet for this type of product. It is very important for safe treatment that you discuss the use of any other medication with your thrombosis service and pharmacy. Vitamin K Acenocoumarol and Fenprocoumon are Vitamin K inhibitors and ensure that your blood clot less quickly. They inhibit the effects of vitamin K, an important part of our blood clotting. Based on the INR value, it is possible to determine how many tablets you should take in the coming period. If the INR is much too high, the doctor can give vitamin K to be able to quickly lower the INR to a normal value. Vitamin K is used in all our foods, which is useful, but it also ensures that the effect of your anticoagulant tablets can be reduced. How do you deal with your food? In principle, the rule applies: if you eat normal and varied, food usually does not have much influence on the

5 effectiveness of your anticoagulant treatment. You certainly do not have to follow a strict diet. Do you follow a slimming diet? This can directly affect your INR value. Always report it to your Thrombosis Service. Stress Whether stress affects the effect of your anticoagulant treatment is difficult to investigate. In practice, we see that the INR of people taking vitamin K inhibitors often increases in stress situations. Stress hormones may cause a disturbance of the liver and / or bowel function. This can have an effect on your anticoagulant treatment. Accessibility of the Thrombosis Service By telephone, the thrombosis service is available on weekdays, available for questions or passing on details, from 8:30-17: 30 on Preferably call in the morning. If we cannot immediately pick up the phone, you can leave a message and we will call you back as soon as possible. Keep your dosing calendar on hand when you call. You can also call the ADC Helpdesk at You can also to trombosedienst@adcnv.com For emergencies in the evening and at weekends: consult your physician on duty. If necessary, the doctor can call the Thrombosis dosing physicians or refer you to the on-duty internist (Sehos). ADC locations: phone Mon-Fri Barber, Kaya Irene Schoop :00-10:30 Mahuma, Schonegevelstraat :00-11:00 Montaña, Montagne Rey 87 A :00-11:00 Muizenberg, Medical Center Elohim :30-11:00 Otrabanda, Roodeweg 13 E :00-14:00 Santa Rosa, Santa Rosaweg :00-11:00 Vredenberg, Heelsumstraat :00-14:00 Hamelbergweg Pater Eeuwesweg Prikboutique Salinja galleries A With best regards, The ADC Trombosis team Heelsumstraat 55 Curaçao Tel. Trombosedienst Tel. Helpdesk Fax Trombosedienst

SAMPLE ONLY. UCSF Division of Pediatric Hematology/Oncology Anticoagulation Service (415)

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