PMID- 35531906
OWN - NLM
STAT- MEDLINE
DCOM- 20221116
LR  - 20221116
IS  - 1525-1594 (Electronic)
IS  - 0160-564X (Linking)
VI  - 46
IP  - 12
DP  - 2022 Dec
TI  - Use of nafamostat mesilate for anticoagulation during extracorporeal membrane 
      oxygenation: A systematic review.
PG  - 2371-2381
LID - 10.1111/aor.14276 [doi]
AB  - BACKGROUND: Extracorporeal membrane oxygenation (ECMO) represents an advanced 
      option for supporting refractory respiratory and/or cardiac failure. Systemic 
      anticoagulation with unfractionated heparin (UFH) is routinely used. However, 
      patients with bleeding risk and/or heparin-related side effects may necessitate 
      alternative strategies: among these, nafamostat mesilate (NM) has been reported. 
      METHODS: We conducted a systematic literature search (PubMed and EMBASE, updated 
      12/08/2021), including all studies reporting NM anticoagulation for ECMO. We 
      focused on reasons for starting NM, its dose and the anticoagulation monitoring 
      approach, the incidence of bleeding/thrombosis complications, the NM-related side 
      effects, ECMO weaning, and mortality. RESULTS: The search revealed 11 relevant 
      findings, all with retrospective design. Of these, three large studies reported a 
      control group receiving UFH, the other were case series (n = 3) or case reports 
      (n = 5). The main reason reported for NM use was an ongoing or high risk of 
      bleeding. The NM dose varied largely as did the anticoagulation monitoring 
      approach. The average NM dose ranged from 0.46 to 0.67 mg/kg/h, but two groups of 
      authors reported larger doses when monitoring anticoagulation with ACT. 
      Conflicting findings were found on bleeding and thrombosis. The only NM-related 
      side effect was hyperkalemia (n = 2 studies) with an incidence of 15%-18% in 
      patients anticoagulated with NM. Weaning and survival varied across studies. 
      CONCLUSION: Anticoagulation with NM in ECMO has not been prospectively studied. 
      While several centers have experience with this approach in high-risk patients, 
      prospective studies are warranted to establish the optimal space of this approach 
      in ECMO.
CI  - (c) 2022 International Center for Artificial Organ and Transplantation (ICAOT) and 
      Wiley Periodicals LLC.
FAU - Sanfilippo, Filippo
AU  - Sanfilippo F
AUID- ORCID: 0000-0001-5144-0776
AD  - Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", 
      Catania, Italy.
FAU - Curro, Jessica Marika
AU  - Curro JM
AD  - School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, 
      Italy.
FAU - La Via, Luigi
AU  - La Via L
AD  - Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", 
      Catania, Italy.
FAU - Dezio, Veronica
AU  - Dezio V
AD  - Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", 
      Catania, Italy.
FAU - Martucci, Gennaro
AU  - Martucci G
AUID- ORCID: 0000-0001-8443-2414
AD  - Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC Italy, Palermo, 
      Italy.
FAU - Brancati, Serena
AU  - Brancati S
AD  - Department of General Surgery and Medical-Surgical Specialties, University of 
      Catania, Catania, Italy.
FAU - Murabito, Paolo
AU  - Murabito P
AD  - Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", 
      Catania, Italy.
AD  - Department of General Surgery and Medical-Surgical Specialties, University of 
      Catania, Catania, Italy.
FAU - Pappalardo, Federico
AU  - Pappalardo F
AD  - Department of General Surgery and Medical-Surgical Specialties, University of 
      Catania, Catania, Italy.
AD  - CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio 
      e Cesare Arrigo, Alessandria, Italy.
FAU - Astuto, Marinella
AU  - Astuto M
AD  - Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", 
      Catania, Italy.
AD  - Department of General Surgery and Medical-Surgical Specialties, University of 
      Catania, Catania, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20220509
PL  - United States
TA  - Artif Organs
JT  - Artificial organs
JID - 7802778
RN  - 9005-49-6 (Heparin)
RN  - Y25LQ0H97D (nafamostat)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Heparin/adverse effects
MH  - Anticoagulants/adverse effects
MH  - Retrospective Studies
MH  - Hemorrhage/etiology
MH  - *Thrombosis/etiology/prevention & control/drug therapy
OTO - NOTNLM
OT  - ECMO
OT  - bleeding
OT  - cardiopulmonary bypass
OT  - heparin resistance
OT  - heparin-induced thrombocytopenia
OT  - thrombosis
OT  - unfractionated heparin
EDAT- 2022/05/10 06:00
MHDA- 2022/11/18 06:00
CRDT- 2022/05/09 05:44
PHST- 2022/03/10 00:00 [revised]
PHST- 2022/01/04 00:00 [received]
PHST- 2022/04/18 00:00 [accepted]
PHST- 2022/05/10 06:00 [pubmed]
PHST- 2022/11/18 06:00 [medline]
PHST- 2022/05/09 05:44 [entrez]
AID - 10.1111/aor.14276 [doi]
PST - ppublish
SO  - Artif Organs. 2022 Dec;46(12):2371-2381. doi: 10.1111/aor.14276. Epub 2022 May 9.