Korean J Nephrol.  2011 Jan;30(1):61-66.

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

Affiliations
  • 1Dialysis Center, College of Medicine, Hallym University, Seoul, Korea.
  • 2Department of Internal Medicine, Kidney Research Institute, College of Medicine, Hallym University, Seoul, Korea. km2071@unitel.co.kr

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 (on-going 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.

Keyword

Nafamostat; Anticoagulation; Renal dialysis

MeSH Terms

Dialysis
Guanidines
Hemorrhage
Heparin
Humans
Mesylates
Renal Dialysis
Thrombosis
Guanidines
Heparin
Mesylates
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