Trombosedienst -Engels

Your physician has prescribed anticoagulants for you, which entails either phenprocoumon (Marcoumar) or acenocoumarol tablets. The Thrombosis Service of the Coagulation Centre performs the routine blood testing and monitoring that are necessary for this type of treatment.

This informational pamphlet provides you with information on both what the Coagulation Centre does for you and what is crucial for you to know.

'Useful Information for Thrombosis Patients', a pamphlet published by the Thrombosis Foundation, is also recommended.

Important websites :

Thrombosis Foundation: www.trombosestichting.nl

Federation of Dutch Thrombosis Services: www.fnt.nl 

The Coagulation Centre is a regional service; therefore, the Coagulation Centre is open to all in North Limburg who are receiving anticoagulant therapy. Your GP or a specialist may also refer you to the Coagulation Centre, either as an outpatient or after being discharged from the hospital or a care home.

Referral via a GP or specialist

Your GP or medical specialist will furnish the relevant information if they refer you to the Thrombosis Service. At which point, the Coagulation Centre can either initiate or continue treatment with anticoagulants.

Referral after being admitted to hospital

A nursing ward or personnel at the hospital's Transfer Office can also register you with the Coagulation Centre. In which case, your treating specialist will likely have already begun treating you with anticoagulants during your hospital stay.

Upon your discharge, the specialist will ask the Coagulation Centre to take over your treatment with phenprocoumon (Marcoumar  ) or acenocoumarol.

You will be referred to the Thrombosis Service, a division of the Coagulation Centre, if you have experienced an embolism or thrombosis or if you are at a higher risk of thrombosis. The Coagulation Centre will guide you on how to use the tablets properly and perform the necessary blood checks. You will regularly visit the blood testing laboratory or another location to have your blood sampled. After the blood’s clotting time is determined, the dosing consultant or dosing physician decides how many tablets you should take (see the section ‘Determining the number of anticoagulant tablets) and when to schedule your next blood check.

Dosing consultant

Dosing consultants are trained and authorised to dose these medications (the medical responsibility, however, remains with the physicians of the Coagulation Centre). The number of tablets to be taken is indicated on the dosage calendar.

Monitoring

Routine blood monitoring is an important component of your anticoagulation therapy. Your blood should neither clot too quickly nor too slowly. Your chance of developing a blood clot or thrombosis rises if your blood clots too readily. Blood that clots too slowly can increase your risk of bleeding or make it more difficult to stop any existing bleeding.

Choosing the blood sampling location

The hospital's blood sampling service holds numerous regional consult hours at a wide variety of locations, such as civic centres, health centres, village or community centres as well as hospitals, nursing facilities and care homes.

For the most updated overview, visit www.viecuri.nl/bloedafname

Please note! Blood sampling at all VieCuri locations is done by appointment only.

Due to medical and/or social reasons, the treating physician or your GP may request to visit your home in order to collect a blood sample. The Coagulation Centre will notify you about when the lab technician will visit your home to take your blood sample (typically in the morning).

Self-monitoring

You can learn to measure your clotting time yourself at the Coagulation Centre using a finger-prick device.

You will receive a course on how to do this.

Upon successful completion, you will receive a certificate.

This does not, however, mean that you bear the final responsibility. That remains with the staff of the Coagulation Centre. You can always switch back, permanently or temporarily, to using the blood sampling services of the Coagulation Centre.

For more information, please telephone the Coagulation Centre.

In case of hindrance on the day of your blood check

You should respect the date of the blood check as much as possible. Sometimes, however, this may prove impossible. In that case, you can have your blood tested one or two days prior to your scheduled blood check. If even that will not be possible, we kindly request that you contact the Coagulation Centre on the day of the scheduled blood check.

We are available Monday through Friday

8:30am - 12.00 noon and 1:00pm - 4:30pm.

Determining the number of anticoagulation tablets

A staff member at the testing location will collect a sample of your blood. Next, your blood sample will be dispatched to the hospital’s laboratory. Here, we test how fast your blood clots

(i.e. clotting time expressed as the ‘INR’ or International Normalised Ratio). Based on the results and any other information (e.g. use of medication or illness), the Coagulation Centre will recommend how many tablets you should take and when you should come for another blood check. We will then send you a new dosage calendar, which you will receive by post the day after the blood sampling.

Dosage modification on the day of the blood sampling

Due to the blood sampling results, care professionals may decide to modify your dosage right away. Therefore, on the day of the blood sampling, we ask that you remain available by telephone between the hours of

2:30pm - 4:30pm. This is so that we can call you or your housemate about the modification of your dosage.

Your new dosage calendar

The new dosage calendar will indicate the number of tablets to take from the first day after the blood sampling through to the second day after your next blood sampling. On the day of the blood sampling, you will still take the number of tablets listed on your old dosage calendar.

Online dosage calendar

You can also view your dosing calendar online on your computer. E-mail or telephone the the Coagulation Centre to request this online access. You can also receive your paper-based dosage calendar at home by post.

What is the dosage of the anticoagulant based on?

The blood sampling results are important. Your treating physician will decide how much your blood should be 'diluted'. This depends on the condition for which you are being treated.

If the blood sampling results fall within the target range several times in a row, the period between your blood checks can be lengthened. However, this will never be longer than a period of six days. If your blood is too 'thick' or too 'thin', you will need to come in for blood checks earlier to minimise your risk of thrombosis or bleeding.

Aside from the blood sampling results, other matters play a role in the medical advice, such as:

Upper section :

This section lists your address details.

Middle section :

This section lists the start date, your anticoagulant medication and the date of your next blood check.

Below that, the dosage calendar displays the dosage for the number of tablets per day.

Dosage :

1.00 = take 1 tablet

0.50 = take ½ (half) a tablet

To the right of this is the INR result (the latest blood results).

Bottom section :

In this section, you can enter the necessary information to create your new dosage calendar. You can enter this information at home or have the lab technician complete it during the blood sampling.

• Bring the bottom section of your dosage calendar with you each time you visit the Coagulation Centre. Please notify the Coagulation Centre of any changes to your address, telephone number, health insurer and/or GP.
• On the day of the blood sampling, make sure you can be reached by telephone between the hours of 2.30 - 4.30pm, so we can call you in case of any modification to your dosage.
• Make sure to always take your tablets according to the instructions on the dosage calendar. The best time to swallow your tablets is before your evening meal. To avoid any mistakes, set a cross onto the dosage calendar immediately after taking your medication.

• If you have not received your dosage calendar one day after your blood sampling, you can proceed with your old dosage. You should contact the Coagulation Centre on the following working day.
• Always take the exact number of tablets prescribed on the dosage calendar. Never experiment with the number of tablets yourself. If you are unsure about the number of tablets to take, telephone the Coagulation Centre or let us know via a notification on your dosage calendar at the next blood sampling.
• If you forget to take your tablets one time, contact the Coagulation Centre the following working day. They will tell you exactly how to proceed. Never swallow the forgotten tablet(s) on the next day . This could be dangerous .
• Frequent blood testing and/or modifications to the number of tablets you take is not related in any way to the severity of your illness or the status of your health.
• If you become ill (flu, fever, vomiting and/or diarrhoea), notify your GP and the Coagulation Centre immediately. You may need to go in for a blood check sooner than planned.
• You might also need to undergo treatment by a physician or a dentist. For example, a minor surgical procedure in hospital or a tooth extraction by a dentist.

If so, always tell them you are under treatment at the Coagulation Centre. If you will be undergoing a procedure, call the Coagulation Centre yourself on the next working day. During this phone call, a staff member will ask about the date and time of the procedure as well as the kind of treatment it entails. If you do not have the necessary details at that time, you should call the Coagulation Centre back once the date is known. The Coagulation Centre will then tell you whether you should take fewer or no tablets and for how long. You will also be told when to have your blood sampled and when to begin taking the tablets again. All of this will be recorded on paper for you and sent by post.

• Unexpected hospitalisation. If you are urgently admitted to hospital, tell the physician and nurses that you are under the treatment and monitoring of the Coagulation Centre. Show them the letter you received about dosing.
  If you know well in advance that you will be hospitalised, call the Coagulation Centre right away.

It is important for the Coagulation Centre to know the reason for your admission and/or your diagnosis or diagnoses.

• If your hospitalisation lasts longer than two days, your anticoagulant therapy will be taken over by the treating specialist until your discharge from hospital.
• Never take other medications at your own initiative. Do not take 'harmless' medication either, such as painkillers, cough syrups and laxatives.You may always take paracetamol as a painkiller, but you must absolutely never take aspirin for your pain.When you are having blood sampled, indicate any vitamins or dietary supplements that you are taking.If you would like to start taking dietary supplements, be sure to tell the salesperson that they should not contain vitamin K (often listed on packaging as ‘listesphytomenadione’). Vitamin K completely blocks the action of phenprocoumon (Marcoumar) or acenocoumarol.  Vitamin E enhances the action of vitamin K; therefore, it is also not desirable.Coagulation Centre staff also need to know whether you are taking any homeopathic remedies or natural medicines. And if so, which ones.
• If your physician prescribes you any new medications , tell him or her that you take anticoagulants. Your physician is likely already aware of this, but it never hurts to give a reminder.

If your physician prescribes new medication for you, contact the Coagulation Centre by telephone the same day or the following working day. Be sure to notify the centre also in case you have already stopped a medication or will be . The reason for this is that some medications either enhance or weaken the effect of anticoagulants.

• Individuals who are undergoing anticoagulant therapy do not need to follow a special diet. You do not have any dietary restrictions. Drink alcohol in moderation. Some dietary supplements contain a significant amount of vitamin K. If you have a normal, varied diet, this is rarely an issue. Do not consume large amounts of beef or pork liver nor of alfalfa, broccoli, endive or brassicas, such as Brussels sprouts. In case of doubt, contact the Coagulation Centre.
• You have a slightly higher risk of bleeding . This is a normal aspect of your treatment. Typically, any bleeding you experience will not be that bad. Examples include a gum wound that does not close right away, a nosebleed or bruising. Do not panic in case of bleeding, but do call the Coagulation Centre for advice. You may experience bleeding that involves larger amounts of blood or is more severe in nature . For example, if your urine is reddish and cloudy, if your stools look black and sticky or if your period is heavy. Do not hesitate, telephone the Coagulation Centre and your GP or the Emergency Medical Centre immediately (on weekdays 5:00pm - 8:00am and on weekends).
• If you have holiday plans , please notify the Coagulation Centre in good time. You can still have your blood tested a few days prior to your departure. Please note that thrombosis services usually do not exist abroad like they do in the Netherlands. Most countries, however, do have locations for blood monitoring. Be aware that you cannot have your blood sampled everywhere while travelling abroad. When choosing your holiday destination, this may be smart to bear in mind.

The Coagulation Centre will send you a special letter about holidays. Among other things, the letter states that you are under the treatment of the Coagulation Centre. This letter is usually written in the language of the country where you will by holidaying.

Do not forget to bring this letter on your trip!

• Anticoagulants can be harmful when taken during pregnancy . Therefore, it is important for women taking anticoagulants who would like to become pregnant to discuss this properly with their physician and consult with the Coagulation Centre as soon as possible. Increasingly, anticoagulants are not taken during pregnancy and the period of breastfeeding. Instead, a different kind of blood thinner is prescribed. It is very important to stop taking anticoagulants at the very start of the pregnancy. Then, telephone the Coagulation Centre immediately. You can visit the Emergency Medical Centre (Spoedpost) outside of office hours, if necessary.
• Not everyone needs to know that you are being monitored by the Coagulation Centre. However, we do advise you to inform family members and those close to you (in both your personal and work life) . Given that you are more prone to bleeding, we recommend carrying a list with you that indicates all of your current medications. This is in case something happens to you while you are in an unfamiliar environment.
• If your treating physician allows you to stop taking anticoagulants, the Coagulation Centre must be notified about this in writing or by telephone by the physician or the consultation assistant and (preferably) also by you. Your deregistration from the Coagulation Centre, if required, will subsequently be confirmed in writing.

In case issues arise

If you are experiencing issues,

you can contact the Coagulation Centre on weekdays (8.30am - 12 noon & 1:00pm - 4.30pm).

+31 (04) 78 52 23 48

In case of urgent medical issues after 5:00pm and before 8.30am, please contact the Coagulation Centre via VieCuri’s central phone number on

+31 (0)77 320 55 55 or the Emergency Medical Centre (Spoedpost) on 0900 88 18.

Your treating physician or pharmacist can quickly contact Coagulation Centre staff via VieCuri’s central phone number. This staff member can always consult an experienced physician with the Thrombosis Service.

Hospitalisation in Germany

When admitted to a care facility in Germany, such as a hospital, the following medications are always prescribed as anticoagulants: phenprocoumon (Marcoumar  ) or warfarin. These medications sometimes cause problems in patients who are taking acenocoumarol. Therefore, if you are discharged from a German hospital or other care facility, it is very important that you directly telephone the Coagulation Centre.

Comments, suggestions or complaints

Do you have any comments, points for improvement or complaints about your treatment or stay on the ward? If so, be sure to let us know. You can call the quality officer at the Coagulation Centre on +31 (0)77 320 52 20.

Feeling unsatisfied after your consultation at the Coagulation Centre? Unable to discuss your questions or comments directly? If so, a complaints officer can be of service. +31 (0)77 320 61 50

Visit www.viecuri.nl/complimentofklacht

VieCuri Patient Panel

Would you like to have your say on important issues concerning VieCuri? More than 500 people have already participated! For more information, visit www.viecuri.nl/patientenpanel and sign up!

Client Council

The client council receives the patient panel’s findings and advises the hospital administration regarding these and other pertinent issues. The client council represents the interests of VieCuri’s patients. A representative from the Coagulation Centre participates in the hospital's client council.

For more information, please contact the secretariat of the client council at +31 (0)77 320 55 55.

Good to know

Hospital treatments, admissions or appointments involve matters that probably did not come to mind immediately. We have listed some of them for you in the pamphlet 'Good to know':

• Waiting times
• Costs for hospital care
• Registration and identification
• Patient and care provider’s rights and duties
• Complaints
• Interpreter for deaf, hard of hearing and non-Dutch speakers
• Privacy
• Rules and regulations
• Medical file inspection
• Life and death issues (e.g. do not resuscitate)
• Infection prevention
• VieCuri house rules
• Scientific research

If you still have questions after reading this pamphlet, do not hesitate to contact us:

Noord-Limburg Thrombosis Service (Trombosedienst)

+31 (0)4 78 52 23 48

(Available weekdays 8:30am - 12.00 noon and 1:00pm - 4:30pm).

E-mail: trombosedienst@viecuri.nl

In case of out-of-hours urgent medical issues (after 5pm and before 8:30am),

call the Coagulation Centre via VieCuri’s central phone number on 077 320 55 55 or call the Emergency Medical Centre (Spoedpost) directly on 0900 88 18.

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