Between a clot and a hard place

[RightSide]

These days, I seem to be having difficulty titrating the right dose of heparin to get me through the hemodialysis session safely.

Once I got a fistula, I found that I have a tendency to bleed after the session:  I'll be all bandaged up and ready to leave the dialysis center,  and suddenly the punctures will pop open again and the blood will start spurting out.

So my neph cut my heparin dose to reduce these bleed episodes.

Still had problems.

So he cut it again.

Now I still get a bleeding episode maybe once a month, but I can live with that.

Unfortunately, 2 days ago, at this lower dose of heparin, my blood clotted and they couldn't return it to me at the end of the session--even though they had done saline flushes every half hour.  The blood suddenly clotted in minutes, and nobody knows why.

But this doesn't happen all the time either.

What I don't understand is why it's so variable: Most sessions, everything goes fine.  Occasionally, as I'm leaving the center, I start bleeding again and have to rush back there to control the bleeding.  And once in a blue moon, like last Tuesday, the blood clots up and I don't get my blood back at the end of the session.

Is there something I'm doing to myself that's causing these variations? Does diet affect clotting time?

[LoneHighway]

YES!!! Diet certainly does affect clotting. Heparin is short acting but Coumadin users know anything with vitamin K, mostly green leafy vegetables, will adversely affect your clotting time.  The treatment for too much coumadin is to give vitamin K by IV.

The bottom line is, if you binge on spinach, greens or broccoli you will be more likely to clot without upping the heparin.

[Nephrologista]

Prolonged bleeding after decannulation can be a sign of rising pressures inside the fistula, which can be caused by a developing stenosis.  Have you had a fistulogram?  Have they looked at the central veins?