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KMID : 0359920110300010061
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Korean Journal of Nephrology
2011 Volume.30 No. 1 p.61 ~ p.66
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Low-Dose Nafamostat Mesilate in Hemodialysis Patients at High Bleeding Risk
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Kim Eun-Yi
Lee Young-Ki
Lee Seung-Min
Choi Myung-Jin
Song Young-Rim
Kim Su-Jin
Park Tae-Jin
Kim Seong-Gyun
Oh Ji-Eun
Seo Jang-Won
Yoon Jong-Woo
Koo Ja-Ryong
Kim Hyung-Jik
Noh Jung-Woo
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Abstract
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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 (ongoing 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).
Conslusion: In patients at high bleeding risk, low-dose nafamostat mesilat can be used as an inexpensive, effective, and safe anticoagulant for hemodialysis.
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KEYWORD
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Nafamostat, Anticoagulation, Renal dialysis
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