Nafamostat mesilate for anticoagulation in continuous renal replacement therapy.

Abstract

PURPOSE:

During continuous renal replacement therapy (CRRT), anticoagulation of the extracorporeal circuit is required. The aim of this study was to assess the efficacy and safety of nafamostat mesilate, a serine protease inhibitor, compared with heparin.


METHODS:

We retrospectively studied 222 patients treated with CRRT in the intensive care unit (ICU). Clinical and filter-related data were extracted.


RESULTS:

We reviewed the medical records of the patients treated with CRRT. Initial anticoagulation methods were 56 heparin and 25 nafamostat mesilate; 10 patients received infused heparin systemically, and 131 patients were treated without anticoagulation. Total number of filters used was 1,236. Median filter lifespan with nafamostat mesilate was significantly greater than heparin (24.3 vs. 17.5 hours, p<0.001) and Kaplan-Meier survival plots revealed the longer survival of the circuits using nafamostat mesilate than heparin or without anticoagulation. In Cox proportional hazard models, nafamostat mesilate predicted longer filter survival. Although nafamostat mesilate induced activated partial thromboplastin time prolongation in 11 circuits (5.4%), bleeding episodes were not increased. 


CONCLUSIONS:

Nafamostat mesilate anticoagulation was associated with prolonged filter survival compared with heparin. These data suggest that nafamostat mesilate is a good choice for anticoagulant with prolonged filter survival during CRRT in critically ill patients.

• Authors: Seun Deuk Hwang, Yu Kyung Hyun, Sung Jin Moon, Sang Choel Lee, Soo Young Yoon
• Journal: The International journal of artificial organs (Int J Artif Organs) Vol. 36 Issue 3 Pg. 208-16 (Mar 2013) ISSN: 1724-6040 [Electronic] United States
• PMID: 23404639 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Benzamidines
• Guanidines
• Heparin
• nafamostat

Topics

• Acute Kidney Injury (blood, therapy)
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Benzamidines
• Female
• Guanidines (therapeutic use)
• Heparin (therapeutic use)
• Humans
• Male
• Middle Aged
• Renal Replacement Therapy (methods)
• Retrospective Studies
• Treatment Outcome