Safer Oral Anticoagulation

Helping People Help Themselves: An Instruction Kit for Coumadin Patients

Research and clinical trials have shown that instructing patients correctly on the use of their medication, produces positive long-term emotional and physical results. This knowledge heightens their level of responsibility and has a significant impact on the effectiveness of the medication. "Empowering patients by having them participate in managing their medical treatment, adds an important dimension to the quality of their treatment,” says Prof. Brezis Meir, head of the Center for Clinical Quality and Safety at theHadassah University Medical Center. “The more information patients have and the greater role they take in managing their medical treatment, the more successful will be the outcome."

Coumadin, the world’s most prescribed anticoagulant, is a proven case in point. It was for this purpose that the Center developed an instruction manual for patients taking this medication, in order to maintain the proper clotting level of their blood.

While still in the hospital, patients are taught how to monitor their blood’s clotting level and determine the appropriate dosage of anticoagulant. Just before discharge, the patient is given a questionnaire to evaluate his "coumadin" understanding. Upon release, the patient receives two kits – one for personal use and one for the family physician. The patient's kit is very compact and contains a colorful, illustrated brochure about coumadin in Hebrew, Arabic, Russian or English, as well as a special ruler (with illustrated instructions) for finding the exact dosage according to the most recent blood test. In addition, the family doctor's kit contains software to help calculate the optimal dose of coumadin and medical literature on the self-monitoring of oral anticoagulants.

With Prof. Brezis Meir's guidance, Dr. Chanan Goldberg, a graduate of the Hebrew University-Hadassah School of Medicine, created the kit as a thesis project for his medical degree. Dr. Goldberg is currently serving as a physician in Israel Defense Forces paratrooper corps.

An estimated six million people worldwide take anticoagulants for a variety of reasons or diseases – and coumadin, also known by its generic name warfarin, is the most popular. About 40,000 people inIsrael take coumadin. In order for the medication to be safe and efficient, the dosage must be correct and the patients’ clotting system kept balanced. The clotting system is measured in International Ratio units (INR) that must be within one of two ranges:2.0-3.0 or 2.5-3.5. Only one-third of the patients who take anticoagulants stay within the correct range; all others are at risk of bleeding from over dosage, or of clotting from under dosage.

Research, both abroad and at Hadassah, now shows that empowering patients to self-manage their medication remarkably improves efficacy and safety of anticoagulation.

Hadassah's patients are responding enthusiastically to the new coumadin kits which are the first instruction manuals of their kind in Israel. Israel's medical community has been very positively impressed and Israeli HMOs are very interested in using the kits.

Lois Gordon of Hadassah’s Center for Safety and Clinical Quality edited and designed the kits as well as the innovative rulers. Yochi Ben David, RN, led the project from its start at Department of Cardiac Surgery at Hadassah and was in charge of the training of patients. Family physician Dr. Tuvia Baevsky of the Klalit Sick Fund, developed the special software for calculating dosages.

Who to contact to obtain kits:
For individuals: Aliza Roash at 02-6777110
For Hadassah departments: Lois Gordon at 77375
Kupat Holim Leumit members can obtain kits directly from their sick fund.



Target INR 2.0 - 3.0
Target INR 2.5 - 3.5


Target INR 2.0 - 3.0
Target INR 2.5 - 3.5


Target INR 2.0 - 3.0
Target INR 2.5 - 3.5


Target INR 2.0 - 3.0
Target INR 2.5 - 3.5

Computer Programs:
English Program
English Instructions

Hebrew Program
Hebrew Instructions

Instructions for English Slide Rules:
Target INR 2.0 - 3.0
Target INR 2.5 - 3.5

Instructions for Hebrew Slide Rules:
Target INR 2.0 - 3.0
Target INR 2.5 - 3.5
Can Patient Involvement Improve Effectiveness & Safety of Oral Anticoagulation at Hospital Discharge? (Hebrew thesis)

Center Publications

Patient Empowerment in Coumadin Therapy
Self-Management of Coumadin Therapy

More on anticoagulation

Drug & food interactions
Safety indicators
Meta-analysis of self-monitoring & self-management of anticoagulation
Department form for patient receiving coumadin kit