Park Jin-Han, Her Charles, Min Ho-Ki, Kim Dong-Kie, Park Si-Hyung, Jang Hang-Jea
Department of Internal Medicine, Inje University, College of Medicine, Haeundae Paik Hospital, Busan - Republic of Korea.
Department of Anesthesiology and Pain medicine, Inje University, College of Medicine, Haeundae Paik Hospital, Busan - Republic of Korea.
Int J Artif Organs. 2015 Nov;38(11):595-9. doi: 10.5301/ijao.5000451. Epub 2015 Dec 16.
Anticoagulation is mandatory for extracorporeal membrane oxygenation (ECMO), but systemic heparinization, which has been most widely used as an anticoagulant, has been associated with bleeding complications. The present study reviewed the usefulness and safety of nafamostat mesilate as a regional anticoagulant in patients with bleeding complication during ECMO.
We retrospectively reviewed the record of 13 cases. The nafamostat mesilate dose was regulated to maintain the activated clotting time (ACT) or activated partial thromboplastin time (aPTT) values within an adequate range at the ECMO reinfusion route. ACT or aPTT values in blood samples from the ECMO circuit and from the patients were measured simultaneously and consecutively.
We measured the ACT value in 6 cases and aPTT in 7 cases. The bleeding complications were treated in 11 cases. When we compared the difference in 2 anticoagulation values (ACT and aPTT) between the 2 blood samples, one taken from ECMO and the other from patients, mean anticoagulation values of blood from patients were lower than those from ECMO circuit in 11 cases. With respect to the type of ECMO reinfusion mode, the difference was significant only in veno-arterial mode ECMO group (p<0.001).
Nafamostat mesilate, with which we can reduce anticoagulation values of patient to a safe level without losing the ECMO anticoagulation values is expected to be useful as a regional anticoagulant in patients with bleeding complications or a high risk of bleeding during ECMO.
体外膜肺氧合（ECMO）治疗时必须进行抗凝，但作为抗凝剂最广泛使用的全身肝素化与出血并发症相关。本研究回顾了甲磺酸萘莫司他作为区域抗凝剂在ECMO期间有出血并发症患者中的有效性和安全性。
我们回顾性分析了13例患者的记录。调节甲磺酸萘莫司他剂量，以维持ECMO再灌注途径处活化凝血时间（ACT）或活化部分凝血活酶时间（aPTT）值在适当范围内。同时连续测量ECMO回路和患者血样中的ACT或aPTT值。
我们测量了6例患者的ACT值和7例患者的aPTT值。11例患者的出血并发症得到治疗。当我们比较取自ECMO的血样和取自患者的血样这两种血样的两种抗凝值（ACT和aPTT）的差异时，11例患者血样的平均抗凝值低于ECMO回路血样的平均抗凝值。就ECMO再灌注模式类型而言，仅在静脉-动脉模式ECMO组差异有统计学意义（p<0.001）。
甲磺酸萘莫司他可将患者的抗凝值降低至安全水平，同时不降低ECMO的抗凝值，有望作为区域抗凝剂用于ECMO期间有出血并发症或出血风险高的患者。
