Objective To explore the efficacy and safety of nafamostat mesylate (NM) in patients on continuous renal replacement therapy (CRRT) at a high risk of hemorrhage.

Methods From March 2021 to February 2022, a retrospective study was conducted for 61 CRRT patients at a high risk of hemorrhage in intensive care unit of Shanghai Changhai Hospital. They were assigned into two groups of NM anticoagulation (n=33) and no anticoagulation (n=28). The effectiveness, safety and economy of anticoagulation were assessed.

Results Baseline profiles differed insignificantly between two groups. No obvious adverse reactions occurred during treatment. The anticoagulant effective rate of NM anticoagulation group was significantly higher than that of no anticoagulant group (93.9% vs 28.6%, P<0.001). Activated partial thromboplastin time (APTT) of venous jug during treatment was significantly higher than pre-treatment (72.9±8.9) vs (42.3±6.6) s, P<0.001 and also higher than that of contralateral peripheral blood during CRRT (72.9±8.9) vs (43.0±5.5) s, P<0.001. No significant change of APTT occurred before and after CRRT (42.3±6.6), (43.0±5.5), (42.3±5.6) s, P>0.05. The elevation of venous pressure was significantly higher in heparin free anticoagulant group than that in NM group (P=0.001) and the level of transmembrane pressure was also higher than that in NM group at the end of treatment (P=0.003). No significant change occurred in hemoglobin level before versus after CRRT in NM group (P>0.05).

Conclusion NM is a safe and effective anticoagulant for CRRT patients at a high risk of hemorrhage and allows sufficient filter survival without a higher risk of hemorrhage.