title: Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy.
abstract: OBJECTIVE
  Nafamostat mesilate (NM) can be used as a regional anticoagulant for continuous renal replacement therapy (CRRT). The primary aim of this study was to assess the association of the use of NM with risk of bleeding complications and compare it with the use of unfractionated heparin (UFH).
  
  
  METHODS
  We conducted a single-center retrospective observational study. We included adult patients who required CRRT in our intensive care unit from 2011 to 2013. The primary outcome was the risk of bleeding complications during CRRT and the secondary outcome was filter life for the first filter of CRRT.
  
  
  RESULTS
  We included 101 patients (76 with NM, 25 with UFH). Among the 101 patients, use of NM tended to be associated with lower risk of bleeding complications (6.6% vs. 16%; odds ratio, 0.37; p = 0.16). Propensity score matching generated 30 patients with NM and 15 patients with UFH with well-balanced baseline characteristics. Among the propensity score-matched cohorts, use of NM was significantly associated with decreased risk of bleeding complications (3.3% vs. 27%; odds ratio, 0.09; p = 0.04). In multivariate logistic analysis using the inverse probability of treatment weighting for sensitive analysis, the use of NM was independently associated with reduced risk of bleeding complications (p = 0.02). The median filter life was not significantly different for patients with NM and patients with UFH (25.5 hours vs. 30.5 hours, p = 0.16).
  
  
  CONCLUSIONS
  In our retrospective analysis, the use of NM as an anticoagulant during CRRT was associated with decreased incidence of bleeding complications compared with the use of UFH.
authors: Department of Anesthesiology, Kobe University Hospital, Kobe - Japan.
authors: Shohei
authors: S
authors: Makino
authors: Department of Anesthesiology, Kobe University Hospital, Kobe - Japan.
authors: Moritoki
authors: M
authors: Egi
authors: Department of Clinical Engineering, Kobe University Hospital, Kobe - Japan.
authors: Hiroshi
authors: H
authors: Kita
authors: Post Graduate Student of Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe - Japan.
authors: Yuji
authors: Y
authors: Miyatake
authors: Department of Anesthesiology, Kobe University Hospital, Kobe - Japan.
authors: Kenta
authors: K
authors: Kubota
authors: Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe - Japan.
authors: Satoshi
authors: S
authors: Mizobuchi
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001550:Benzamidines; D003422:Critical Care; D005260:Female; D006146:Guanidines / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D017582:Renal Replacement Therapy / Q000295:instrumentation; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; D006493:Heparin; C032855:nafamostat