OET letter for a patient on anticoagulants: writing doses, blood tests and bleeding risk clearly
In an OET Nursing letter about a patient on an anticoagulant (a blood thinner), state why you are writing first, then give exactly what the reader must continue or check: the medicine name, dose and schedule copied from the case notes, the date and purpose of the next blood test if the notes give one, any recent bleeding or fall, and who is responsible for monitoring. Write doses and dates in one unambiguous format and never add dosing or monitoring advice that is not in the notes.
When the anticoagulant is the key content
Many case notes list an anticoagulant among a patient's medicines. Whether it belongs in the letter depends on what the reader needs to do. It is usually key content when:
- the medicine was started, changed or stopped during the admission,
- the reader must arrange or check a blood test,
- the patient had bleeding, bruising or a fall,
- the medicine must be held or resumed around a procedure,
- the patient or carer needs support to take it correctly.
If none of these apply, a brief mention or a reference to the enclosed medication list may be enough. Use the case-notes selection guide to decide.
Accuracy note: this is a writing guide, not prescribing or monitoring guidance. Copy medicine names, doses, target ranges, blood-test dates and instructions exactly from the case notes. Do not add dosing advice, target ranges or warnings from your own knowledge.
Writing doses and dates without ambiguity
Small slips in a dose or a date are the most serious errors in this kind of letter, because the reader may act on them.
| Unclear | Clear |
|---|---|
| "Warfarin 3mg/4mg alt days" | "She takes warfarin 3 mg and 4 mg on alternate days, as shown on the enclosed chart." |
| "INR 4.1 → dose held x1" | "Her INR was 4.1 on 12 May, so one dose was withheld." |
| "Next INR Fri" | "Her next INR test is due on Friday 16 May." |
| "Enox until mobile" | "She is receiving enoxaparin injections until she is fully mobile, as charted." |
| "Bleeding gums – minor" | "She reported minor bleeding from her gums on 10 May." |
Tips:
- Keep one unit style throughout (for example "3 mg", with a space).
- Give the day and date for blood tests; "Friday" alone can be misread.
- Pair a test result with its date, and state what was done if the notes say.
- Copy any target range only if the notes give it.
See how to write vital signs and test results and dates and times in OET letters.
What to include and what to leave out
| Usually include | Usually leave out (unless it changes care) |
|---|---|
| Reason for the letter and main request | Why the anticoagulant was first started years ago, in detail |
| Medicine name, dose and schedule as written | Older blood results that are not part of the story |
| Recent change and the reason, if in the notes | General explanations of how the medicine works |
| Most recent relevant result with date | Every result from the admission |
| Next blood test date and who arranges it | Ward routines |
| Bleeding, bruising or falls the notes report | Hobbies and social details with no effect on care |
| Support with medicines (carer, blister pack) | Advice not found in the notes |
Worked example (invented case)
Notes (invented): Mr Desmond Okafor, 72. Atrial fibrillation, on warfarin 5 yrs. Admitted 8 May with nosebleed lasting 2 h, stopped with packing. INR 4.1 on admission (target range in notes: 2–3). Warfarin withheld 1 day, then dose reduced: now 3 mg Mon/Wed/Fri, 2 mg other days (chart enclosed). INR 2.6 on 12 May. Discharged home 13 May. Next INR 16 May at practice nurse clinic. Lives with wife, who helps with medicines (uses weekly pill organiser). Mild bruising on forearms noted. Enjoys gardening, retired bus driver. Letter to GP, Dr Hannah Lowe.
Letter body:
I am writing to inform you of the discharge of Mr Okafor, aged 72, who was admitted with a nosebleed and whose warfarin dose has been reduced. I would be grateful if you could review his INR on 16 May.
Mr Okafor has atrial fibrillation and has taken warfarin for five years. He was admitted on 8 May with a nosebleed lasting two hours, which stopped after nasal packing. His INR on admission was 4.1, above his target range of 2 to 3.
His warfarin was withheld for one day, and his dose has been reduced to 3 mg on Mondays, Wednesdays and Fridays and 2 mg on other days, as shown on the enclosed chart. His INR was 2.6 on 12 May, and he was discharged home on 13 May. Mild bruising was noted on both forearms.
His wife helps him with his medicines using a weekly pill organiser. His next INR test is booked at your practice nurse clinic on 16 May.
The letter leaves out his former job and gardening. It keeps the wife's role because the new dose schedule depends on the organiser being changed. Every number comes from the invented notes.
Common mistakes
- Copying an abbreviation that has two meanings. Write the medicine and test names as the notes give them, and expand any shorthand such as "alt" or "x1". See OET writing abbreviations.
- Separating a result from its date. "INR 2.6" without a date is less useful.
- Writing "blood thinner" to a GP. Use the medicine name with a clinical reader; plain words suit a non-clinical reader.
- Missing who does the next test. The reader should know whether they must arrange it or whether it is already booked.
- Adding advice. Do not tell the GP what the target range "should" be or how to adjust the dose.
For more on medicines in general, see how to write medications in an OET letter.
Practise and check
Practise a timed letter at /writing/, or check a letter you have written to get an estimated grade, a mark for each of the six criteria and line-by-line corrections. medEmu is an independent practice tool for OET Writing for Nursing; its grades are estimates, and it is not affiliated with OET.
Sources
This guide is medEmu's writing advice, not official OET guidance and not clinical or prescribing advice; all patients, doses, results and plans are invented for practice, and a real letter must follow the case notes and local guidance. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.