Consensus in initial management of acute pancreatitis (3rd Edition)

Shimosegawa, Tooru; Ito, Tetsuhide; Akashi, Ryuukichi; Igarashi, Hisato; Isaji, Shuji; Inui, Kentaro; Okazaki, Kazuichi; Kataoka, Keisuke; Kamisawa, Terumi; Kawa, Shigeyuki; Kitagawa, Motoji; Kihara, Yasuyuki; Shimizu, Kyoko; Shiratori, Keiko; Takeda, Kazunori; Takeyama, Yoshifumi; Naruse, Satoru; Nishimori, Isao; Hirota, Masahiko; Hirota, Morihisa; Furuya, Tomoki; Masamune, Atsushi; Mayumi, Toshihiko; Mine, Tetsuya

doi:10.2958/suizo.26.651

Cited by 5 publications

(1 citation statement)

References 29 publications

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“…However, the guidelines for acute pancreatitis also state that it is important to discontinue or reduce the dose of nafamostat mesylate as soon as improvement is observed based on clinical symptoms and laboratory or imaging findings. 21) This suggests that the reduction or discontinuation of the dose of nafamostat mesylate needs to be discussed among healthcare professionals according to the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Identification of Risk Factors for Phlebitis in Patients Treated with Nafamostat Mesylate

2023

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The proteolytic enzyme inhibitor nafamostat mesylate is widely used for the treatment of acute pancreatitis and disseminated intravascular coagulation. This drug may be a risk factor for phlebitis, but this risk has not been studied. Therefore, we aimed to investigate the frequency of phlebitis and its risk factors in patients treated with nafamostat mesylate in intensive care units (ICU) or high care units (HCU). During the study period, 83 patients met the inclusion criteria, and 22 of them (27%) experienced phlebitis. A multivariate logistic regression analysis was performed for severe acute pancreatitis, administration duration, and administration concentration of nafamostat mesylate in the ICU or HCU. As a result, the administration of nafamostat mesylate for ≥ 3 days in the ICU or HCU was an independent predictor of phlebitis caused by nafamostat mesylate (odds ratio, 10.3; 95% confidence interval, 1. 28-82.5; p=0.03). This study suggests that the number of days of nafamostat mesylate administration is associated with phlebitis in patients treated with the drug, and it may be necessary to pay attention to its administration for ≥ 3 days in the ICU or HCU.

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Section: Discussionmentioning

confidence: 99%

Identification of Risk Factors for Phlebitis in Patients Treated with Nafamostat Mesylate

2023

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Efficacy of nafamostat mesylate in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis of randomized controlled trials

Narumi,

Okada,

Lin

et al. 2023

Sci Rep

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We conducted a systematic review and meta-analysis to evaluate the effect of nafamostat on the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). PubMed, Web of Science, and Ichushi Web were searched for randomized controlled trials (RCTs) using nafamostat to prevent PEP. In subgroup analyses, we studied the preventive effects of nafamostat according to the severity of PEP, risk category, and dose. A random-effects model was adopted; heterogeneity between studies was examined using the chi-squared test and I2 statistics. This analysis uses the PRISMA statement as general guidance. 9 RCTs involving 3321 patients were included. The risk of PEP was lower in the nafamostat group than in the control group [4.4% vs. 8.3%, risk ratio (RR): 0.50, 95% confidence interval (CI): 0.36–0.68]. In subgroup analyses, the protective effects were evident in low-risk patients for PEP before ERCP (RR: 0.34, 95% CI: 0.21–0.55). The association between PEP and nafamostat was significant only in patients who developed mild PEP (RR: 0.49; 95% CI: 0.36–0.69). The benefits were independent of the dose. The prophylactic use of nafamostat resulted in a lower risk of PEP. The subgroup analyses suggested uncertain benefits for severe PEP or high-risk patients for PEP. This warrants further investigation through additional RCTs.

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