If a patient reports yesterday’s GI bleeding but feels better today, which anticoagulation adjustment is most likely indicated?

• A. Increase heparin dose
• B. No change
• C. Reduce heparin dose
• D. Switch to a different dialyzer

Answer: (C)

Balancing bleeding risk with the need to keep the dialysis circuit from clotting is the key idea. After a GI bleed, anticoagulation should be reduced to lower the chance of rebleeding, especially if the patient has stabilized today. Reducing the heparin dose lessens the ongoing anticoagulant effect, which helps protect the patient from further bleeding while still providing some protection against clot formation in the circuit. If the circuit starts to clot, you can reassess and adjust again or consider heparin-free dialysis with saline flushes, but switching dialyzers doesn’t address anticoagulation and keeping the dose the same could risk rebleeding. Increasing the dose would raise bleeding risk.