Anticoagulation Center
Your doctor has referred you to our center for careful monitoring and adjusting of your Coumadin® (Warfarin). This is important because Coumadin® lengthens the time it takes your blood to form a clot and carries with it some risks. The Center is staffed by clinical pharmacists under direct supervision of the medical director of the center. The center serves patients who are 18 years old or older. Although you will be coming to this clinic, you need to see your regular doctor as well.
Anticoagulation Center Locations
Mount Carmel East
5965 East Broad St. Suite 200 Columbus, Ohio 43213
614-234-8844 phone
614-234-8850 fax
Mount Carmel West
730 West Rich St.
Columbus, Ohio 43222
614-234-9842 phone
614-234-9829 fax
Mount Carmel St. Ann's
444 N. Cleveland Ave. Suite 220
Westerville, Ohio 43082
614-234-4064 phone
614-234-4062 fax
Mount Carmel Grove City (Tuesday's only)
5350 North Meadows Dr.
Suite 220
Grove City, Ohio 43123
614-234-9843 phone 614-234-9829 fax
Hours and Appointments




Monday - Friday 8:00 a.m. to 4:30 p.m. Call the center to make or change an appointment.
Please arrive 10-15 minutes early for your first visit.
If you are going to be late or if you are not able to keep an appointment, call the center
as soon as possible.
What to Expect on Your First Visit
Your first visit will last about one hour. Bring a list of all the drugs that you are now taking.
This includes prescription drugs, over-the-counter drugs, and herbal and other dietary supplements. This list and your health history form will be reviewed. You may view a brief video about Coumadin®, and receive instructions and information about taking the medication. You will also receive the results of your PT/INR test.
PT/INR Testing
A Protime test (PT/INR) is a key tool in checking your body’s response to Coumadin® and in adjusting the dose. It is a blood test that measures the time it takes for your blood to form a clot. When you begin taking Coumadin®, you will have the PT/INR test once or twice per week until the test results are stable. After this, the PT/INR test will be done every four weeks. The test takes only a few minutes. Your finger will be stuck to obtain a small amount of blood.
Insurance and Billing
We accept most major medical insurance plans. The cost at each visit will include the fee for the clinic visit plus a charge for the finger stick and lab work. You must pay your office visit co-pay during your visit. Call the business office at 614-234-8888 if you have any questions about your bill. As A Patient of this Center, You Will Be Expected to:

Return to the Anticoagulation Center for regular PT/INR tests on appointed days. If you must miss an appointment, call to reschedule.

Take your Coumadin® as instructed. 
Inform all of your doctors, dentists, and health care providers that you are taking Coumadin® (warfarin).
Call the Center if you have any of these Signs of Bleeding:

Any unexplained, sudden bleeding from the nose, mouth, or rectum

Extra heavy menstrual periods

Unusual bruises or bruises becoming larger

Red or dark brown urine 
Red or tarry black stools

Vomiting blood or “coffee ground” liquid

Coughing up blood
Also Call the Center if:

You have questions or concerns about your Coumadin®.

You are starting on a new medication or have changes made to the other drugs that you take, such as antibiotics, pain medications, or any over-the-counter drugs such as pain pills, antacids, laxatives, cold/flu pills, herbal supplements, or vitamins.

You have any major illness, infection, or hospital visits.

There are major changes in your diet.

You become pregnant or are planning pregnancy.

You must stop taking Coumadin® (Warfarin) for a short time before a procedure or surgery you are having.

You miss a dose.

You are switched from the brand name Coumadin® to the generic Warfarin or from the generic Warfarin to the brand name Coumadin®.
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Take these Precautions to Avoid Bleeding 
Protect your body from injury. Use a soft toothbrush and see your dentist regularly. Take extra caution when using knives, scissors, tools and saws. Avoid activities in which you may hit your head.

Inspect your skin daily for black and blue marks. A lot of bruising may be a concern when taking Coumadin®. Call the clinic is you notice a lot of bruises.

Take your Coumadin® at the same time each day. 
Eat a balanced diet. Avoid changing current foods that you eat. Avoid drinking alcohol and following fad diets. If you must be on a special diet, please let us know.

Always carry an Emergency Medical Identification Card or emblem that states that you are taking Coumadin®.
Go to the Emergency Room if you:

Are advised to do so by your doctor or by the Anticoagulation Center staff.

Are coughing up blood and are not able to reach your doctor or the Center staff.

Have bleeding that does not stop after 20 minutes of direct pressure.

Have a major injury, such as a severe fall or large cut (especially to the head).

Have fainting, severe weakness, or abdominal pain that does not go away.
Completing the Health Questionnaire The health assessment questionnaire is needed for information about your medical history and any risk factors that may be important to your Coumadin® therapy. Please answer the questions in a way that best describes your current health status. Confidentiality
The personal information you share will remain confidential between you and the Mount Carmel Anticoagulation Center staff involved in your treatment program.
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MOUNT CARMEL ANTICOAGULATION CENTER
NEW PATIENT HEALTH ASSESSMENT
Instructions: The health assessment questionnaire is designed to obtain information about your medical history and identify any risk factors that may be important to your Coumadin® (Warfarin) therapy. Please answer the questions in a way that best describes your current health status. Confidentiality:
The personal information you share will remain confidential between you and the Mount Carmel Anticoagulation Center staff.
PLEASE FILL OUT AND RETURN ON YOUR NEXT VISIT
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Anticoagulation Center
Personal Information
□Mr.
□Mrs.
□Ms.
□Miss □________
Date: ___________
Name: ________________________________________ Date of Birth: ____________
Address: _______________________________________________________ Apt #: ________
City: ___________________
State: ______
Social Security # ______-___-______
Employed:
□Yes
□No
Zip Code: _________
Phone Number: _______________ Cell Phone: ____________
□Retired
□Part-time
□Full-time
Employer Name: _____________________________ Work Phone: _______________
Marital Status:
□Single
Race: □African-American
□Married
□Caucasian
□Divorced
□Hispanic
□Widowed
□Native-American
□Other _____
Primary care physician: _________________________________________
Emergency Contact Information:
Name: _______________________________________
Relationship: __________________________
Phone Number: _____-______-_______
Allergies: □Food: _______________________________________________ Type of Reaction: ________________
□Medication: ___________________________________________Type of Reaction: ________________
□Environmental/Seasonal: ______________________________________
□Latex
□None
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Social History:
Tobacco: What type ___________
Amount: __________
□None Quit date: ___________
Alcohol: What type ___________
Amount: __________
□None
Illicit Drugs: What type ________
Amount: __________
□None
Caffeine: What type ___________
Amount: __________
□None
Have you ever been treated for drug/alcohol addiction?
□Yes
□No
Family History: Heart disease before age 55
□Yes
□No
Relationship: _____________
Heart disease over age 55
□Yes
□No
Relationship: _____________
Diabetes
□Yes
□No
Relationship: _____________
High Blood Pressure
□Yes
□No
Relationship: _____________
Bleeding Issues
□Yes
□No
Relationship: _____________
Blood clots (DVT, PE)
□Yes
□No
Relationship: _____________
Stroke
□Yes
□No
Relationship: _____________
Cancer: Type ____________
□Yes
□No
Relationship: _____________
High Cholesterol/Triglycerides
□Yes
□No
Relationship: _____________
□History unknown
Surgical History:
1.
______________________________________________Year: _________
2.
______________________________________________Year: _________
3.
______________________________________________Year: _________
4.
______________________________________________Year: _________
5.
______________________________________________Year: _________
6.
______________________________________________ Year: _________
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Past Medical History: (Check ALL that apply)
□ Congestive heart failure
□ Parkinson’s disease
□Heart Attack
□Tuberculosis
□Bypass surgery
□Chronic bronchitis
□Heart Valve Replacement
□Diabetes
□Pacemaker
□Thyroid disease
□Defibrillator
□Hepatitis/Liver problems
□Atrial Fibrillation
□Arthritis
□Atrial Flutter
□History of Seizures
□Arrhythmias
□Chronic pain
□Mitral Valve Prolapse
□HIV/AIDS
□Artery Blockage
□Depression/Anxiety/Panic attacks
□Carotid Blockage
□Multiple sclerosis
□Angioplasty
□Lupus
□Abdominal Aortic Aneurysm
□GERD/Acid Reflux
□Angina (Chest pain)
□Irritable bowel syndrome
□Stroke/TIA/”mini stroke”
□Peptic Ulcer
□DVT/Phlebitis
□Enlarged prostate
□High Blood Pressure
□Kidney disease
□High Cholesterol
□Migraines
□Pulmonary Embolism
□Fibromyalgia
□Asthma
□Sexually transmitted disease
□COPD
□Genetic clotting disorder Type: __________
□Emphysema
□Cancer
□Recurrent pneumonia
□Joint Replacement
Type: __________________
Type: ___________
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Anticoagulation Information:
□Brand (Coumadin®)
□Generic (warfarin)
Date Coumadin® (warfarin) started: _________________ Dosage: _______________ Dose time: __________
Have you ever taken Coumadin® or warfarin previously? □Yes
□No
Year: _______
If yes, have you ever had any problems with bleeding while on Coumadin®? □Yes □No
If yes, describe: __________________________________________________________
Medications/Vitamins/Supplements
Please list ALL prescription and over-the-counter medications, vitamins, supplements, herbs, and dietary supplements that you take. Attach separate sheet for additional medications if needed. Name of Drug
Dose
Times per day
Reason for taking
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Advanced Directive:
Do you have a living will?
□Yes
□No
Do you have a medical power of attorney?
□Yes
□No
Other Considerations:
Is English your primary language?
□Yes
□No
if no, what language: ____________
If not, will you need assistance with communication/translation?
□Yes
□No
Do you have difficulty hearing? □Yes
□No
Do you use hearing aids?
Do you have any vision problems?
□Yes
□No
Do you have difficulty walking? □Yes
□No
Do you use:
Do you use a pillbox?
□No
□Yes
□Yes
□Glasses/Contact lenses
Do you have difficulty remembering to take your medications?
□Walker
□Yes
□No
□Color blind
□Cane
□No
For Office Use Only
Health Questionnaire reviewed and confirmed by
Date
Clinician Signature
Rev 8/08, 8/10, 9/11
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Coumadin®
(Warfarin Sodium Tablets, USP)
Coumadin® (warfarin) is a medication that range. Your blood is “too thick.” slows the blood clotting process. It is called Abnormal blood clots may form as a an anticoagulant, meaning, “against blood result of an INR that is too low.
clotting.” Clots can cause serious problems when they lodge in blood vessels in the legs, 
An increased INR reading or one that is above your target range means that your lungs, heart, or brain. Coumadin does not blood is less likely to clot. This puts you break up clots that are already formed, but it at a higher risk for bleeding problems may help keep clots from getting larger.
than when the INR is in your target Coumadin® (warfarin) is used for people range. Your blood is “too thin.” This who have either recently formed a blood could cause bruising or bleeding.
clot or who are at risk for forming blood clots. It may be prescribed for:

Blood clots in the legs and lungs or the Taking Your Coumadin®

time each day.
prevention of these clots


Atrial fibrillation – an irregular heart-

If you miss a dose, take it as soon as beat that can lead to the formation of possible. If you don’t remember until the clots next day, do not take a double dose. Go back to your regular schedule.
Prevention of clots after a heart valve replacement

Take your Coumadin about the same 
Keep a daily Coumadin record. Use the chart on the back pages. Stroke prevention

Tell your doctor if you have missed any doses.
How it Works
Coumadin® (warfarin) alters your body’s ability to form blood clots. The Cautions
Coumadin® dose often needs to be 
adjusted several times when your doctor Contact your doctor right away if you think you may be pregnant. Coumadin® first prescribes it in order to achieve the (warfarin) is not safe for pregnant target range - where your blood is not too women.
“thick” or too “thin.” You will be having INR blood tests, which show how “thick” 
before starting or stopping any or “thin” your blood is:

Check with your pharmacist or doctor medication. This includes over-the-
A decreased INR reading or one that is counter medication, herbal products, lower than your target range means that vitamins, or supplements.
your blood is at a higher risk for clotting than when the INR is in your target 
Avoid alcohol. 10
Diet and Coumadin

Ginger
Vitamin K is important for clotting of 
Horseradish
blood. Foods that are rich sources of 
Cranberry & cranberry juice

Grapefruit and grapefruit juice

Pineapple & pineapple juice

Pomegranate & pomegranate juice

Black licorice & black jelly beans
your diet could alter the effect of the drug. 
Red cayenne pepper
Foods that are moderate to high in vitamin The key thing to remember is to avoid K can decrease INR readings and may major changes in vitamin K intake in make your blood “too thick.” Do not make your diet from week to week. A steady or any major changes in how much you eat consistent diet is very important.
vitamin K can affect how well Coumadin® works. While a moderate amount of vitamin K is needed and will have no effect on your Coumadin® therapy, drastic changes in or drink of these foods. If you like these foods and eat them often, you can continue to do so, but you need to be consistent. High Vitamin K Foods
Herbal and Dietary Supplements
Many dietary supplements such as ginkgo, St John’s wort, and arnica can change the INR. Much is unknown about dietary 
Broccoli
supplements. Always check with your 
Brussel sprouts 
Collard greens
doctor before taking a nutritional or herbal supplement.

Kale

Mustard greens

Turnip greens
bleeding so it is important to follow these 
Spinach
precautions. Moderate Vitamin K Foods

Asparagus

Cabbage

Green leaf and Romaine lettuces (iceberg lettuce is low)
Bleeding Precautions
®
The main side effect of Coumadin
is Talk with your doctor or pharmacist about any questions or concerns.
Report to your doctor:

stop, including bleeding from shaving, brushing your teeth, nosebleeds, and These foods and drinks may cause your other cuts.
blood to become “too thin” and increase INR readings. Do not make any major changes in how much you eat or drink of these:

Alcohol

Papaya

Bing cherries

Garlic
Any bleeding that takes a long time to 
Severe bruising or bruising for unknown reasons

Red or dark brown urine

Red or black bowel movements

Dizziness, headache, or weakness
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Also report to your doctor:


straining. Increase the fiber in your diet Very heavy or continual menstrual and drink more fluids. Ask your nurse or periods, or unexpected vaginal bleeding dietitian for diet suggestions.
(You may have a heavier and longer period, the same length but heavier, all.)
for pain or over-the-counter medication.
Use only a soft toothbrush. 
Shave carefully. You may want to use an electric razor. Wear shoes at all times.

Blow your nose gently.

Avoid using enemas, suppositories, tampons, and douches
Activity 
Anti-Inflammatory Medications
Anti-inflammatory medications can also cause bleeding as a side effect. Check with your doctor before taking any of these medications. Some common anti-
inflammatory medications are:
® 
Advil
(ibuprophen)

Aleve
(naproxen)

Ibuprofen, Motrin
(ibuprophen)

Naprosyn
(naproxen)
® ®
®
Do not take aspirin or aspirin-containing Change positions slowly. Sit on edge of medicines unless advised by your doctor. bed one or two minutes before you Many medications contain aspirin stand. If you are unsteady on your feet, (acetylsalicylic acid). These can be ask for help each time you want to stand prescription and over-the-counter and be or walk.
used to treat arthritis, colds and pain, etc. Avoid contact sports that could easily result in injury.

Check with your doctor, nurse, or pharmacist before taking any medication 


longer but the same flow or no change at Hygiene 
Take stool softeners as needed to prevent Make sure to carefully read the labels. Ask your doctor or pharmacist, if you have any questions.
Avoid cutting with sharp knives or working with sharp blades.
Some Products Containing Aspirin

Use gloves when gardening.
Alka-Seltzer Plus Sinus

Avoid tight-fitting clothing such as skirts Alka-Seltzer with Aspirin
or slacks with tight waistbands.
Alka-Seltzer Plus Cold 
Although sexual intercourse is not Alka-Seltzer Extra Strength
restricted, use a water-based lubricant Anacin Caplets and Tablets
like K-Y Jelly® if needed.
Arthritis Pain Formula
Arthritis Strength BC Powder
To Prevent Problems:

At the site of bleeding, apply firm pressure right away for five minutes or until bleeding stops. If bleeding does not stop, call your doctor or go to the Emergency Room.
Ascriptin
Aspergum
Aspir-Low
Aspirtab
Bayer Aspirin Products
12
Some Products Containing Aspirin (continued)
Bayer Children's Aspirin
BC Powder
Buffasal
Anticoagulation Medication –
Taking it Safely
Bufferin Products
Canasa Suppositories
Doan’s Backache Plus
View this helpful video program on Channel 5 at any of these times:
Easprin
6:05 am, 9:00 am, 12:55 pm, Ecotrin Products
6:05 pm, 9:00 pm, 12:55 am Equagesic
Equaline
Ask a staff member if you need help Excedrin products – Back and Body,
with finding the program.
Extra Strength
Fiorinal Capsules and Tablets
Fiorinal with Codeine Goody’s Powders
Goodsense Products
Halfprin Products
Healthprin Products
Kaopectate
Menstrual Complete Migraine
Momentum
Norwich Aspirin Products
Orphenedrine
Orphenedrine Forte
PAC Analgesic Tablets
Pepto Bismol
Percodan Soma Compound
Soma with Codeine
St. Joseph’s Aspirin
Stanback Powder
Stanback Max Powder
Synalgos-DC
Tri-Buffered Aspirin Products
13
Coumadin® (warfarin) Calendar
Month
Day
Dose
Time Taken
PT/INR
Appointments
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
14
Coumadin® (warfarin) Calendar
Month
Day
Dose
Time Taken
PT/INR
Appointments
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
15
You can cut this out, fill it in, and carry it in your wallet.
I am taking Coumadin® (Warfarin Sodium Tablets, USP)
This medication prevents blood clots from forming.
Please tell this right away to anyone providing care to me.
Name
Birth date
Weight
Other medications/conditions
In an emergency, call:
Relationship
Phone #
Doctor’s Name
Phone #
Rev..9/08, 6/09, 3/10, 8/10, 7/11, 8/11, 9/13, 5/14, 10/14, 1/15
© Mount Carmel 2015
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