Low-Dose Nafamostat Mesilate in Hemodialysis Patients at High Bleeding Risk

Korean Journal of Nephrology 2011;30(1):61-66.

Eun Yi Kim1, Young-Ki Lee, Seung Min Lee, Myung-Jin Choi, Young Rim Song, Soo Jin Kim, Tae Jin Park, Sung Gyun Kim, Jieun Oh, Jang Won Seo, Jong-Woo Yoon, Ja-Ryong Koo, Hyung Jik Kim and Jung-Woo Noh

Dialysis Center¹
Department of Internal Medicine²
Kidney Research Institute, College of Medicine, Hallym University, Seoul, Korea

원저 : 출혈 위험을 가진 혈액투석 환자에서 저용량 nafamostat mesilate의 효과

김은이1, 이영기2, 이승민2, 최명진2, 송영림2, 김수진2, 박태진2, 김성균2, 오지은2, 서장원2, 윤종우2, 구자룡2, 김형직2, 노정우2

한림대학교 강남성심병원 인공신장실1, 한림대학교 의과대학 내과학교실 및 신장연구소2

Abstract

Purpose: Systemic anticoagulation, usually with heparin, is required to prevent thrombosis in the blood circuit of hemodialysis. In patients at high bleeding risk, strategies to minimize the bleeding risk include heparin-free or regional anticoagulation methods. Nafamostat mesilate with conventional dose (35 mg/ hr) has been used for this purpose. But it is an expensive anticoagulant to use conveniently for the dialysis therapy. Application of low-dose nafamostat mesilate has almost never been tried yet on hemodiaysis management. In this study, we examined the effect of low-dose nafamostat mesilate compared to heparin-free in hemodialysis patients with high risk of bleeding. Methods: The current study was conducted on 35 hemodialysis patients with high bleeding risk (ongoing bleeding, hemorrhage, surgery or severe thrombocytopenia). In the low-dose nafamostat group (n=17, mean age: 59±15 years), 238 sessions were performed with continuous infusion of nafamostat mesilate (12.5 mg/hr). In the control group with saline-flushing no heparin methods (n=18, mean age: 57±17 years), 247 sessions were analyzed. Results: No significant differences were found in baseline characteristics between the low-dose nafamostat group and the saline group. In the progress of bleeding complications, there were no significant differences between the two groups (11.8% vs. 11.1%). In saline group, however, massive clotting occurred in 44.5 per 1000 sessions, while it occurred in 4.2 per 1000 sessions in the low-dose nafamostat group (p=0.006). Conclusion: In patients at high bleeding risk, low-dose nafamostat mesilat can be used as an inexpensive, effective, and safe anticoagulant for hemodialysis.

Key Words: Nafamostat, Anticoagulation, Renal dialysis