Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate

Abstract

Background: Bleeding remains the chief concern during extracorporeal membrane oxygenation (ECMO). Recently, several studies proposed nafamostat mesilate (NM) as an alternative anticoagulant to heparin due to reduced bleeding complications and comparable thromboembolic episodes. The aim of this study was to evaluate the clinical outcomes of ECMO anticoagulated mainly with NM. Methods: This was a retrospective observational case series of patients who were placed on ECMO between January 2011 and December 2017 at Chungnam National University Hospital. The main outcomes were bleeding and thromboembolic episodes. Results: During the study period, a total of 91 ECMO runs on 87 patients were identified. There were 54 veno-venous runs and 37 veno-arterial runs. Among the 87 patients, 47 (54.0%) patients were successfully weaned and 29 (33.3%) survived to discharge. Most of the runs were anticoagulated with NM (n=68, 74.7%), followed by heparin (n=22, 24.2%) and argatroban (n=1, 1.1%). The mean duration of ECMO support was 11.3±11.1 days. The overall incidence of bleeding was 46.2% (n=42); 26 runs were anticoagulated with NM (26/68, 38.2%) and 16 with heparin (16/22, 72.7%) (P=0.005). The overall incidence of thromboembolic episodes was 12.1% (n=11). In the NM group, the incidence of hyperkalemia requiring any type of intervention was 17.6% (n=12). Conclusions: In this single center study, NM appears to be associated with fewer bleeding complications during ECMO without increasing the incidence of thromboembolic episodes.

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

“…7 Nafamostat is reportedly associated with fewer bleeding complications during ECMO without increasing the incidence of thromboembolic episodes. 8 Another recent report showed that nafamostat not only had anticoagulant effects but also potential anti-inflammatory and antiviral effects against COVID-19. 4 In the present case, circuit thrombosis was suppressed with the combination therapy, probably because of these anticoagulant and anti-inflammatory effects.…”

“…Nafamostat is reportedly associated with fewer bleeding complications during ECMO without increasing the incidence of thromboembolic episodes 8 . Another recent report showed that nafamostat not only had anticoagulant effects but also potential anti‐inflammatory and antiviral effects against COVID‐19 4 .…”

Evaluation of clinical outcomes in patients treated with heparin or direct thrombin inhibitors during extracorporeal membrane oxygenation: a systematic review and meta-analysis

“…Of these records 4.031 records were excluded for not meeting inclusion criteria for titles and abstracts, leaving 51 potentially relevant articles. Among these articles we identified 25 conference abstracts , 3 studies in which patients were switched between intervention and control group [41][42][43] and 5 studies that investigated nafamostat mesilate but not DTI versus heparin [44][45][46][47][48]. These 33 studies were excluded, leaving 18 studies for inclusion into data synthesis.…”

New Trends, Advantages and Disadvantages in Anticoagulation and Coating Methods Used in Extracorporeal Life Support Devices

“…Similarly, Han et al observed more bleedings with UFH, but 3 cases of intracerebral hemorrhage with NM. Survival was higher in the NM group (38.2% vs. 13.6%) and heparin was found to be the only independent predictor of bleeding complications [ 20 ]. Conflicting results were presented in another retrospective study based on propensity-matched data.…”