Different doses of nafamostat mesilate for patients taking hemodialysis
Objective To explore the anticoagulant effect and safety of different dosages of nafamostat mesylate for patients taking hemodialysis.Methods According to the dosages of nafamostat mesylate,the patients were divided into a 10 mg/h nafamostat mesilate group(33 cases),including 23 males and 10 females who were(58.8±16.0)years old,and a 20 mg/h nafamostat mesilate group(32 cases),including 17 males and 15 females who were(62.6±15.7)years old.All the patients took hemodialysis for 4 h per time,3 times per week.The data were compared between the two groups by independent-sample t test or non-parameter test.The rates of venous clotting,artery clotting,and cumulative catheter blockage were compared between the two groups by Kaplan-Meier survival analysis and log-rank test.Results A total of 65 patients undergoing maintenance dialysis were included;they underwent 178 case times of nafamostat mesilate anticoagulation,including 87 case times in the 10 mg/h nafamostat mesilate group and 91 case times in the 20 mg/h nafamostat mesilate group.There were no statistical differences in gender,age,body weight,height,coronary heart disease,diabetes mellitus,bleeding causes,and laboratory indicators between the two groups(P＞0.05).More patients had venous clotting score of 3 in the 10 mg/h nafamostat mesilate group than in the 20 mg/h nafamostat mesilate group[6.9％(6/87)vs.3.3％(3/91)],with a statistical difference(P＜0.05).The treatment time in the 20 mg/h nafamostat mesilate group was longer than that in the 10 mg/h nafamostat mesilate group[(225.0±21.3)min vs.(217.0±18.1)min],with a statistical difference(t=-2.587;P＜0.05).The pre-dialysis transmembrane pressure and arterial pressure in the 20 mg/h nafamostat mesilate group were significantly lower than those in the 10 mg/h nafamostat mesilate group[(57.0±43.4)mmHg(1 mmHg=0.133 kPa)vs.(77.3±31.2)mmHg and(-82.3±28.9)mmHg vs.(-71.1±29.4)mmHg],with statistical differences(t=3.488 and 2.448;both P＜0.05).The survival analysis showed that there was no statistical difference in the catheter blockage rate between the two groups(P＞0.05).After anticoagulation with nafamostat mesilate,2 cases(3.1％)experienced aggravated bleeding in the 65 patients.Conclusion Anticoagulation with nafamostat mesilate in standard hemodialysis treatment has a low incidence of venous clotting occlusion and minor bleeding risk.The 20 mg/h dosage of nafamostat mesilate exhibits better effectiveness,can reduce the rate of venous clotting and offer a new anticoagulation method for patients taking maintenance dialysis at high risk of bleeding.
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维普
