title: Nafamostat as anti-coagulant for membrane plasmapheresis in high bleeding risk patients.
abstract: Nafamostat mesilate (NM), an ultrashort-acting multi-enzymatic inhibitor, is a useful anti-coagulant in high bleeding risk patients needing hemodialysis. We applied NM as a membrane plasmapheresis (MP) anti-coagulant in patients with high bleeding risk. Eleven patients, the majority with hepatic failure and active hemorrhagic foci or severe bleeding diathesis, could be treated with MP 22 times under anti-coagulation by 20-40 mg/h/NM by continuous infusion without any trouble. Celite-activated coagulation time (CCT) at the plasma separator inlet and outlet was adequately prolonged during MP, but CCT in systemic blood showed no prolongation throughout the procedure, because NM was rapidly inactivated. There was no observable blood coagulation in the extracorporeal circuit including the plasma separator. No adverse reaction or exacerbation of hemorrhage was noted throughout the MP. NM thus appears to be a useful and safe anti-coagulant not only for hemodialysis but also for MP in high bleeding risk patients.
authors.affiliation: Fujigaoka Hospital, Showa University, Yokohama, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Kinugasa
authors.forename: T
authors.initials: T
authors.lastname: Akizawa
authors.forename: Y
authors.initials: Y
authors.lastname: Nakashima
authors.forename: M
authors.initials: M
authors.lastname: Wakasa
authors.forename: S
authors.initials: S
authors.lastname: Koshikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001550:Benzamidines; D001772:Blood Cell Count; D001777:Blood Coagulation / Q000187:drug effects; D005112:Extracorporeal Circulation; D005260:Female; D006146:Guanidines / Q000008:administration & dosage* / Q000009:adverse effects; D006474:Hemorrhagic Disorders / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; C032855:nafamostat