Before a dialysis treatment, if a patient reports yesterday's GI bleed but feels much better today, how is the treatment most likely to be modified?

• A. Increase the heparin
• B. Decrease the heparin
• C. Stop the heparin
• D. Switch to a different anticoagulant

Answer: (B)

When there’s a recent GI bleed, the priority is reducing the risk of further bleeding while still keeping the dialysis circuit open. Lowering the heparin dose accomplishes this balance: it decreases the anticoagulant effect to lessen bleeding risk, but still provides some anticoagulation to prevent clotting of the dialyzer and circuits. Since the patient feels much better today, there’s no need to stop anticoagulation entirely, which would raise the chance of clotting. Increasing heparin would worsen bleeding, and stopping it completely could lead to circuit clotting, while switching to a different anticoagulant isn’t warranted unless there’s a specific reason to avoid heparin. So, the most appropriate modification is to decrease the heparin dose for the session.