Nafamostat Mesilate as an Anticoagulant During Continuous Renal Replacement Therapy in Patients With High Bleeding Risk

Abstract

Nafamostat mesilate (NM), a synthetic serine protease inhibitor, has been used increasingly as an anticoagulant during continuous renal replacement therapy (CRRT). However, there, are limited data from randomized studies on NM use in patients with a bleeding tendency. This prospective study evaluated the efficacy and safety of NM use during CRRT in patients with acute kidney injury (AKI) patients at high risk of bleeding.Patients with AKI at high risk of bleeding were randomized into the NM and no anticoagulant (NA) groups. The primary outcome was the treatment efficacy represented by the filter lifespan. Several parameters, including safety and patient survival rates at 30 and 90 days, were analyzed as secondary outcomes.Fifty-five patients were included in this study (NM group = 31, NA group = 24). The baseline characteristics did not significantly differ between the groups. The mean filter lifespan was significantly longer in the NM group than in the NA group (31.7 ± 24.1 versus 19.5 ± 14.9 hours; P = 0.035). The most common cause of filter failure was filter clotting, which was significantly more frequent in the NA group than in the NM group (59.6% versus 37.7%, P = 0.024). The Cox proportional hazards model showed a 42.2% longer filter lifespan in the NM group compared with the NA group (hazard ratio, 0.578; 95% confidence interval, 0.362–0.923; P = 0.022). There were no significant differences in the frequencies of transfusions and major bleeding between the groups. Patient survival rates at 30 and 90 days after CRRT initiation were comparable between the groups.Nafamostat mesilate is a safe and effective anticoagulant for CRRT and allows sufficient filter survival without increasing the risk of bleeding in critically ill patients with AKI and bleeding tendencies.

Continuous renal replacement therapy in elderly with acute kidney injury

“…There were no significant differences in the rate of transfusion or mortality between the two groups, and no adverse events related to NM were reported. Choi et al [34] included patients at high risk for bleeding who received no anticoagulation (n = 24; age, 58.6 ± 18 years) or NM (n = 31; age, 63.6 ± 11.5 years). The filter lifespan was longer in the NM group than in the no anticoagulation group (31.7 ± 24.1 hours vs. 19.5 ± 14.9 hours, p = 0.035).…”

Successful conservative treatment for massive uterine bleeding with non-septic disseminated intravascular coagulation after termination of early pregnancy in a woman with huge adenomyosis: case report

“…In the present case, nafamostat mesilate was administered because the coagulation function was still activated, and nafamostat mesilate has effects against both excessive coagulation and fibrinolysis to prevent the development of infarcts [19,20]. Administration of heparins alone to fibrinolytic DIC (DIC with a strong fibrinolytic activation) rather promotes bleeding [21][22][23]. Both gabexate mesilate (FOY) and nafamostat mesylate are synthetic serine protease inhibitors and exhibit antithrombin-independent anticoagulant activity [22][23][24][25][26].…”

“…In our view, a drug affecting both coagulation and fibrinolysis should be considered when massive bleeding occurs in patients with huge adenomyosis. Moreover, nafamostat mesylate has a short half-life of 5-8 min and we can quickly switch treatment strategy to surgery if it is judged to be ineffective [21,27].…”

Continuous Renal Replacement Therapy (CRRT) in Children and the Specialized CRRT Team: A 14-Year Single-Center Study

“…The major difference in the use of anticoagulants is that citrate was used in patients with a bleeding tendency in the US study [17], whereas nafamostat mesilate is used in Korea because citrate is not licensed in Korea. In some studies, nafamostat mesilate has been known to have fewer complications, such as hypocalcemia, compared to citrate [22,23]. Because well-trained CRRT-specialized nurses are more efficient in handling nafamostat mesilate, the use of nafamostat mesilate significantly increased after the SCT was established (p < 0.001).…”