Nafamostat Mesilate: A Regional Anticoagulant for Hemodialysis in Patients at High Risk for Bleeding

Akizawa, Tadao; Koshikawa, Shozo; K, Ota; Kazama, Mutsuyoshi; Mimura, Naoya; Hirasawa, Yoshihei

doi:10.1159/000187357

Cited by 91 publications

(70 citation statements)

References 10 publications

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“…Nafamostat mesilate, which has a minimal effect on systemic coagulation, is reported to reduce the risk of increased bleeding caused by hemodialysis to 7.6% in patients with tendency to bleed. 1) Conservative treatment of intracerebral hemorrhage during chronic hemodialysis is recommended for patients with hematomas of moderate size. Stereotactic aspiration is effective for hematomas of moderate size, but outcomes are poor for larger hematomas.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Miyahara¹,

Murata²,

Abé³

2007

Neurol. Med. Chir.(Tokyo)

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The factors associated with hematoma enlargement were analyzed in 24 patients, 16 males and eight females aged 46 to 77 years (mean 58 years), undergoing chronic hemodialysis who were admitted to our hospital with intracerebral hemorrhage between 1994 and 2003. Computed tomography demonstrated hematoma enlargement in eight patients after admission. Age, sex, duration of dialysis, time interval between onset and admission, site of hemorrhage, and blood pressure on admission were not significantly different between patients with and without hematoma enlargement. However, level of consciousness, size and shape of hematoma, prothrombin time, and fibrin degradation product level were significantly different between the two patient groups (p º 0.05). All patients with hematoma enlargement died during the course of treatment. Intracerebral hemorrhage is more difficult to treat in hemodialysis patients than in non-hemodialysis patients, and the outcome is especially poor in patients with large hematoma. The present study suggests that lower level of consciousness, large and irregular hematoma, prolonged prothrombin time, and high fibrin degradation product level are predictors of hematoma enlargement after admission.

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Section: Discussionmentioning

confidence: 99%

Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Miyahara¹,

Murata²,

Abé³

2007

Neurol. Med. Chir.(Tokyo)

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“…We used nafamostat mesilate (FUT) as the anticoagulant during CHDF, because it has been reported to be useful for haemodialysis in patients with a high risk of bleeding such as those with thrombocytopenia. 14 As the haemolysis in our patient obviously improved after the initiation of CHDF (Figure 1), FUT might have shown some efficacy by inhibiting complement activation. 15 In conclusion, the present case indicates that BMT-TM can occur during or immediately after HDC.…”

Section: Discussionmentioning

confidence: 69%

Thrombotic microangiopathy of hyperacute onset after autologous peripheral blood stem cell transplantation in malignant lymphoma

Togitani

Takeyama

Yokozawa

et al. 1998

Bone Marrow Transplant

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Summary:Bone marrow transplant-associated thrombotic microangiopathy (BMT-TM), usually associated with thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and renal insufficiency, has been reported to occur approximately 5-6 months after BMT. We report a case of relapsed malignant lymphoma complicated by BMT-TM of hyperacute onset, which has never been described in the literature. Our patient, a 52-yearold male, developed MAHA with gross haematuria, thrombocytopenia, lactate dehydrogenase elevation and renal insufficiency 2 days after autologous PBSC transplantation following high-dose chemotherapy. Supportive treatment, ie glucocorticoid, fresh frozen plasma and haemodiafiltration were given, and thereafter the BMT-TM gradually improved. In heavily pretreated patients, caution should be exercised for possible occurrence of the BMT-TM of hyperacute onset. Keywords: thrombotic microangiopathy; hyperacute onset; PBSCT; high-dose chemotherapy Thrombotic microangiopathy (TM) in association with BMT (BMT-TM) has been reported by several investigators. 1,2 In the setting of allogeneic BMT, not only conditioning therapy, but also CsA, GVHD and cytomegalovirus (CMV) infection are incriminated as possible factors in the pathogenesis of BMT-TM. 1,2 In autologous BMT, conditioning therapy has been proposed as a cause. 2 Although conditioning-associated TM is generally thought to occur approximately 5-6 months after BMT, 2 we report a case of hyperacute onset (during high-dose chemotherapy (HDC) ) TM following autologous PBSC transplantation (PBSCT). Such hyperacute onset BMT-TM has never been reported in the literature.Correspondence: K Tobinai, Department of Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104, Japan Received 3 October 1997; accepted 28 January 1998 Case reportA 52-year-old man was diagnosed as having stage IV peripheral T cell lymphoma involving retroperitoneal lymph nodes, liver, spleen, and bone marrow in May 1994. He received several regimens of combination chemotherapy (MACOP-B, consisting of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisolone and bleomycin; CHOP, consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone; CHOP-bleo, consisting of CHOP with bleomycin), which produced some response, but his disease progressed and he was referred to our hospital in April 1996. Salvage chemotherapy consisting of etoposide, methylprednisolone, high-dose cytarabine and cisplatin (ESHAP) 3 produced a partial response. The harvested PBSC which were enriched for CD34 + cells were cryopreserved as previously described. 4 Organ function remained within normal limits before the patient received HDC with PBSCT.In August 1996, he was treated with high-dose carboplatin (200 mg/m 2 /day (total dose 1000 mg/m 2 ) ), cyclophosphamide (1200 mg/m 2 /day (total dose 6000 mg/m 2 ) ), etoposide (250 mg/m 2 /day (total dose 1250 mg/m 2 ) ) and dexamethazone (40 mg/day (total dose 200 mg) ) on 5 consecutive days (days Ϫ7 to Ϫ3). Vomiting and diarrho...

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“…Postoperatively, the original hemodialysis schedule should be resumed as soon as possible, though postoperative bleeding due to treatment with anticoagulants may present a problem. In our patients, nafamostat mesilate, an ultra-short-acting anticoagulant that is effective in patients at high risk for postoperative bleeding [14], was administered for anticoagulation prior to postoperative dialysis and there was no clinically significant postoperative bleeding in any.…”

Section: Discussionmentioning

confidence: 89%

Perioperative Complications in Patients with End-Stage Renal Disease Undergoing Pulmonary Resection

Suehiro¹,

Okutani²

2011

J Anesthe Clinic Res

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Introduction: Among the perioperative complications encountered in patients with renal failure, there is a high risk of events such as heart failure and increased susceptibility to infection. Herein, we report the results of our investigation of perioperative management in patients with chronic renal failure who underwent a pulmonary resection. Methods:The subjects were 21 hemodialysis patients with renal failure who underwent pulmonary resection for lung cancer. We retrospectively investigated their clinical characteristics and perioperative management. The patients were classified into two groups; those with and without symptoms of postoperative acute heart failure. Intergroup comparisons of preoperative examinations and management were performed. Results:The most common preoperative comorbidity was cardiac complications, which occurred at a high incidence of 38%. There were no serious perioperative complications. In contrast, postoperative complications associated with renal failure were numerous, including acute heart failure in 3 (14%) and hyperkalemia in 2 (9.5%). We concluded that preoperative respiratory function, intraoperative fluid infusion volume, and preoperative cardiac comorbidities are potential risk factors for postoperative heart failure in such patients. Conclusion:Although there were no cases with perioperative mortality, postoperative complications were encountered, including heart failure and hyperkalemia, suggesting that more stringent cardiovascular and respiratory management techniques are necessary.

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Nafamostat Mesilate: A Regional Anticoagulant for Hemodialysis in Patients at High Risk for Bleeding

Cited by 91 publications

References 10 publications

Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Predictors of Intracranial Hematoma Enlargement in Patients Undergoing Hemodialysis

Thrombotic microangiopathy of hyperacute onset after autologous peripheral blood stem cell transplantation in malignant lymphoma

Perioperative Complications in Patients with End-Stage Renal Disease Undergoing Pulmonary Resection

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