Preventing thrombosis in a COVID‐19 patient by combined therapy with nafamostat and heparin during extracorporeal membrane oxygenation

Abstract

Background Extracorporeal membrane oxygenation (ECMO) can be life‐saving in cases of coronavirus disease (COVID‐19); however, circuit thrombosis is a complication. This report describes a COVID‐19 patient treated with nafamostat and heparin to prevent circuit thrombosis during ECMO support. Case presentation A 63‐year‐old man was transferred to our hospital with respiratory failure due to COVID‐19 pneumonia. He was provided venous‐venous ECMO to maintain oxygenation. During ECMO support, occlusive circuit thrombosis developed despite systemic anticoagulation therapy with heparin. He was subsequently administered combination therapy with nafamostat and heparin. Although the combination therapy could prevent circuit thrombosis, it was converted to heparin monotherapy because of hyperkalemia and hemothorax. After tracheostomy and a gradual improvement in oxygenation, ECMO was discontinued. He was transferred to another hospital for further rehabilitation. Conclusion Combination therapy with nafamostat and heparin can prevent circuit thrombosis during ECMO. However, bleeding can still develop with this combination therapy during ECMO.

Identification of nafamostat mesylate as a selective stimulator of NK cell IFN-γ production via metabolism-related compound library screening

“…NM, a synthetic serine protease inhibitor [32], has been used to treat pancreatitis and acute vasculitis clinically in Japan. NM has been recently shown to be beneficial for patients with coronavirus disease 2019 (COVID-19) in some case reports [33][34][35]. In our study, we found that NM promoted NK cell IFN-γ production in both direct and indirect manners.…”

Broad antiviral and anti‐inflammatory efficacy of nafamostat against SARS‐CoV‐2 and seasonal coronaviruses in primary human bronchiolar epithelia

“…[ 57 ] In fact, a report showed that combination therapy with nafamostat and heparin prevented circuit thrombosis in a COVID‐19 patient during extracorporeal membrane oxygenation. [ 58 ] Similarly, another study found that nafamostat improves COVID‐19 pneumonia in patients requiring supplementary oxygen therapy. [ 59 ] Altogether, these findings highlight a third dimension to beneficial role for treatment of COVID‐19.…”

Therapeutically effective covalent spike protein inhibitors in treatment of SARS-CoV-2

“…Thus, its anti-coagulant and anti-viral properties may help in the management of COVID-19 patients with coagulopathy (Asakura 2020). A case report demonstrated that the combination therapy with nafamostat and heparin is more efficient than heparin monotherapy in stopping circuit thrombosis during venous-venous extracorporeal membrane oxygenation [VV-ECMO] (Doi et al 2020a).…”