Nafamostat mesilate as an anticoagulant during continuous veno-venous hemodialysis: A three-year retrospective cohort study

Introduction: Although nafamostat mesilate, a synthetic serine protease inhibitor, has been commonly used in Japan as an anticoagulant during continuous renal replacement therapy (CRRT), its clinical utility has not been well determined. The aim of this study was to evaluate the efficacy (filter survival) and safety (bleeding complications) of nafamostat mesilate in CRRT for acute kidney injury (AKI) among critically ill patients. Methods: We retrospectively studied consecutive patients with AKI treated with continuous venovenous hemodialysis and nafamostat mesilate from April 2005 to March 2008. Demographic, clinical and laboratory data were extracted from the clinical chart. Results: Fifty-eight patients were enrolled in this study (45 males with an average age of 66 15 years). The median filter survival was 21.8 h (range: 2.8-55.5 h), and the mean was 20.8 +/- 8.4 h. Only 38 out of 181 filters (21%) were interrupted because of filter failure within 24 hours and 89 filters (49%) were electively renewed within 24 hours. Activated partial thromboplastin time was elevated especially during the first 24 hours (46.7 +/- 13.1 s at baseline versus 73.9 +/- 24.3 s at day 1; ANOVA p<0.01). Hematocrit level was kept around 30% and did not change significantly (ANOVA p=0.69). No patients experienced major bleeding while treated with CRRT. Conclusions: Nafamostat mesilate provided sufficient filter survival without causing major bleeding complications despite the prolongation of APTT.