Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Increased blood clotting has a lot of independent risk factors one of them being high hemoglobin. The others are prothrombotic factors which are controlled by Heparin/ Warfarin.
So yes independently it could be a risk factor, however 1 or 2 mg/dL does not increase the risk significantly.
Dialysis patients are given erythropoietin therapy too, to increase the levels of hemoglobin, and if you are on EP, probably that is why your nurse suggested to keep hemoglobin levels around 11.5 mg/dL.
I understand that you require to be in warfarin related to your cardiac condition.So its a must for you and keep a watch on your activity and the dose of the drug. It's important to keep the INR between 2 to 2.5 and preferably not more than that. If INR exceeds there is a chance of bleed any where especially while on hemodialysis where you will receive heparin. A sudden rise in BP during and after HD also would increase the risk of bleeding. If INR is low, then clotting tendency would harm not only the fistula but also the other parts of the body. Fistula clot can be due to several factors like velocity of blood flow , injury to blood vessel endothelium , erythropoietin therapy , smoking , sudden occurrence of low blood pressure etc. warfarin alone would not prevent ( that's what the data proved so far )
Feel free to discuss further,
Regards.