Use of Nafamostat Mesilate as an Anticoagulant during Extracorporeal Membrane Oxygenation

Abstract

Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.

Optimization of Substrate‐Analogue Furin Inhibitors

“…Notably,avery short half-life of 8min is reported for nafamostat, which is used in rare cases for hemodialysis patients with at endency to bleed. [50,51] The orallya vailabled rugsd abi-gatran etexilate and ximelagatran are both applieda sa midine prodrugs, which also limits the plasma concentrations of the free benzamidines. For instance, after oral treatment of 20 mg ximelagatran to healthyv olunteers, plasma levels of 0.2 mmol L À1 were reacheda nd were sufficient for anticoagulant use.…”

Extracorporeal Membrane Oxygenation for Acute Life-Threatening Neurogenic Pulmonary Edema following Rupture of an Intracranial Aneurysm

“…A previous study at our hospital showed that nafamostat mesilate, which has been used widely as an anticoagulant for hemodialysis patients with a tendency to bleed, can be used as an alternative anticoagulant to heparin in order to reduce bleeding complications during ECMO (9). In the present case, ECMO was used successfully with nafamostat mesilate as the anticoagulant, and neurosurgical operations were performed under ECMO therapy.…”

Heparin‐induced thrombocytopenia complicating extracorporeal membrane oxygenation support: Review of the literature and alternative anticoagulants

“…Lim et al90 found that NM was associated with a higher risk of bleeding than heparin in ECMO patients. In contrast, Park et al91 and Han et al92 reported that NM was a safe alternative anticoagulant for ECMO patients with a high risk of bleeding. Nagaya et al93 reported the use of NM in 12 neonates on ECMO who had a high risk of bleeding that was well controlled in eight of these 12 neonates.…”