The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation

Abstract

Background: Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment.

Methods: We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation.

Results: The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group.

Conclusions: NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.

Keywords: nafamostat mesilate; regional anticoagulation; veno-arterial extracorporeal membrane oxygenation.

Figure 1.

Flowchart of patient selection. ECMO: extracorporeal membrane oxygenation; VV-ECMO: veno-venous ECMO; VA-ECMO: veno-arterial ECMO; NM: nafamostat mesilate.

Figure 2.

Comparison of activated partial thromboplastin time (aPTT) values between patients and extracorporeal membrane oxygenation (ECMO) site. (A) The pooled aPTT value in patients was significantly lower than that of the ECMO site in those receiving nafamostat mesilate (NM). (B) The pooled aPTT value was not different between patients and the ECMO site in those receiving heparin before NM. (C) The pooled aPTT value in patients was significantly lower than that of the ECMO site in those receiving NM after heparin. S: sample point. ^aIndicates statistically significant differences between patients and the ECMO site at each sample point.