Patient Care: The patient is observed closely for desired and adverse effects of anticoagulation therapy. This includes assessing the results of laboratory tests (protime, international ratio [INR], activated partial thromboplastin time [aPTT]) specific to the anticoagulant drug being used to regulate dosing and assessing the patient for signs or symptoms of bleeding. Patients requiring long-term use of anticoagulant therapy (usually warfarin) should wear a medic-alert device or carry a card to identify increased bleeding risk. The patient and family are taught the importance of correct dosing and follow-up testing. Patients should inspect themselves regularly for bleeding gums, bruising, petechiae, nosebleed, tarry stools, and blood in urine or vomitus and report such bleeding to the prescribing physician. Patients should avoid OTC products containing aspirin or other salicylates and should discuss other prescribed drugs (or herbal remedies, such as ginkgo biloba) with the prescriber or pharmacist to be sure these will not interfere with their anticoagulant therapy. Patients should use a soft toothbrush and shave with an electric razor. They need to read labels of food and nutritional products and learn about foods and drinks containing vitamin K in order to maintain consistent intake levels and thus avoid altering the desired anticoagulant effect.