Efficacy and safety of namostat mesylate for anticoagulation in patients with extracorporeal mem-brane oxygenation after cardiac surgery
Objective To investigate the anticoagulant efficacy and safety of namostat mesylate in patients with extracorporeal membrane oxygenation(ECMO)after cardiac surgery.Methods From Januar-y 2022 to January 2024,40 patients treated with ECMO after cardiac surgery in Luoyang Central Hospital were divided into experimental group(n=21)and control group(n=19)for anticoagulation therapy by a random number table method.The target value of activated partial thromboplastin time(APTT)was 50-70 s.The activated clotting time(ACT)was 150-200 s.The experimental group was injected intravenously with 0.50-0.75 mg/(kg·h)naphthalmostat mesylate.The control group was intravenously injected with heparin at 7.50-20.0 U/(kg·h).APTT and ACT values of 8 consecutive sample points were compared between the two groups within 24 h after ECMO implantation.APTT value,ACT value,platelet level,platelet transfu-sion volume,hemoglobin level,red blood cell transfusion volume,bleeding event,thrombotic event and in-cidence of excessive anticoagulation were compared between the two groups during ECMO operation.SPSS 26.0 software was used for statistical analysis.T test of two independent samples was used for continuous variables conforming to normal distribution,Mann-Whitney U test was used for continuous variables not conforming to normal distribution,and Chi-square test was used for categorical variables.Results There were no significant differences in number of males[14(66.7％)vs.13(68.4％),P＞0.05],age[(55.8±15.1)years vs.(59.0±7.5)years,P＞0.05],body weight[(67.7±16.6)kg vs.(68.9±18.4)kg,P＞0.05],and ECMO running time[(5.8±2.6)d vs.(4.5±2.5)d,P＞0.05]between the experimental group and the control group.There was no significant difference in platelet count[(162.5±65.9)×109vs.(145.0±87.9)×109,P＞0.05]and hemoglobin level[(9.0±1.4)g/L vs.(9.0±2.5)g/L,P＞0.05]before ECMO between the experimental group and the control group.Within 24 h after ECMO implantation,there was no significant difference between the experimental group and the control group in APTT value[T1(44.6±13.5)s vs.(62.7±23.5)s,P＞0.05;T2(44.9±8.3)s vs.(49.7±11.7)s,P＞0.05;T3(49.7±11.0)s vs.(53.1±10.6)s,T4(47.8±11.0)s vs.(52.4±22.7)s,P＞0.05;T5(48.8±21.4)s vs.(49.0±17.7)s,P＞0.05;T6(40.7±17.2)s vs.(41.9±7.5)s,P＞0.05;T7(49.3±9.9)s vs.(45.5±12.5)s,P＞0.05;T8(46.4±10.1)s vs.(49.4±10.7)s,P＞0.05].Within 24 h of ECMO implantation,there was no significant difference in ACT values between the experimental group and the control group[T1(177.9±20.6)s vs.(202.6±47.2)s,P＞0.05;T2(181.2±22.3)s vs.(196.0±26.4)s,P＞0.05;T3(177.9±19.9)s vs.(185.9±26.3)s;T4(185.0±24.6)s vs.(190.1±30.3)s,P＞0.05;T5(179.6±19.5)s vs.(181.9±24.6)s,P＞0.05;T6(182.1±16.6)s vs.(180.4±25.8)s,P＞0.05;T7(171.3±24.1)s vs.(174.8±22.4)s,P＞0.05;T8(185.5±12.9)s vs.(178.9±25.3)s,P＞0.05].Dur-ing ECMO operation,there was no significant difference between the experimental group and the control group in APTT value[(49.4±11.9)s vs.(52.1±13.1)s,P＞0.05]and ACT[(181.7±11.8)s vs.(188.4±16.6)s,P＞0.05].The platelet count in the experimental group was greater than that in the control group[(87.7±22.2)× 109 vs.(59.8±27.3)× 109,P＜0.05].The platelet transfusion volume in the experimental group was lower than that in the control group[(1.6±0.5)U vs.(2.0±0.4)U,P＜0.05].The hemoglobin level in the experimental group was higher than that in the control group[(8.7±0.9)g/L vs.(7.8±1.2)g/L,P＜0.05].The red blood cell transfusion volume in the experimental group was lower than that in the control group[(7.0±3.4)U vs.(12.4±9.7)U,P＜0.05].The inci-dence of bleeding events in the experimental group was lower than that in the control group[2(12.5％)vs.7(29.2％),P＜0.05].There was no significant difference in thrombotic events between the experi-mental group and the control group[0(0％)vs.2(12.5％),P＞0.05].The incidence of excessive anti-coagulation in the experimental group was lower than that in the control group(6.3％vs.14.7％,P＜0.05).Conclusion Nathomostat mesylate can be used as an anticoagulant during V-A ECMO and is safe and effective in patients who receive ECMO after cardiac surgery.
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