Han Woosik, San Bok Jin, Cho Hyun Jin, Yu Jae Hyeon, Na Myung Hoon, Kang Shinkwang, Kang Min-Woong
Department of Thoracic and Cardiovascular Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
J Thorac Dis. 2019 Jul;11(7):2861-2867. doi: 10.21037/jtd.2019.06.30.
Bleeding remains the chief concern during extracorporeal membrane oxygenation (ECMO). Recently, several studies proposed nafamostat mesilate (NM) as an alternative anticoagulant to heparin due to reduced bleeding complications and comparable thromboembolic episodes. The aim of this study was to evaluate the clinical outcomes of ECMO anticoagulated mainly with NM.
This was a retrospective observational case series of patients who were placed on ECMO between January 2011 and December 2017 at Chungnam National University Hospital. The main outcomes were bleeding and thromboembolic episodes.
During the study period, a total of 91 ECMO runs on 87 patients were identified. There were 54 veno-venous runs and 37 veno-arterial runs. Among the 87 patients, 47 (54.0%) patients were successfully weaned and 29 (33.3%) survived to discharge. Most of the runs were anticoagulated with NM (n=68, 74.7%), followed by heparin (n=22, 24.2%) and argatroban (n=1, 1.1%). The mean duration of ECMO support was 11.3±11.1 days. The overall incidence of bleeding was 46.2% (n=42); 26 runs were anticoagulated with NM (26/68, 38.2%) and 16 with heparin (16/22, 72.7%) (P=0.005). The overall incidence of thromboembolic episodes was 12.1% (n=11). In the NM group, the incidence of hyperkalemia requiring any type of intervention was 17.6% (n=12).
In this single center study, NM appears to be associated with fewer bleeding complications during ECMO without increasing the incidence of thromboembolic episodes.
出血仍然是体外膜肺氧合（ECMO）期间的主要关注点。最近，几项研究提出甲磺酸萘莫司他（NM）作为肝素的替代抗凝剂，因为它可减少出血并发症且血栓栓塞事件相当。本研究的目的是评估主要使用NM进行抗凝的ECMO的临床结局。
这是一项回顾性观察性病例系列研究，研究对象为2011年1月至2017年12月在忠南国立大学医院接受ECMO治疗的患者。主要结局为出血和血栓栓塞事件。
在研究期间，共确定了87例患者进行了91次ECMO治疗。其中有54次静脉-静脉治疗和37次静脉-动脉治疗。在87例患者中，47例（54.0%）成功撤机，29例（33.3%）存活出院。大多数治疗使用NM进行抗凝（n = 68，74.7%），其次是肝素（n = 22，24.2%）和阿加曲班（n = 1，1.1%）。ECMO支持的平均持续时间为11.3±11.1天。出血的总体发生率为46.2%（n = 42）；26次治疗使用NM抗凝（26/68，38.2%），16次使用肝素抗凝（16/22，72.7%）（P = 0.005）。血栓栓塞事件的总体发生率为12.1%（n = 11）。在NM组中，需要任何类型干预的高钾血症发生率为17.6%（n = 12）。
在这项单中心研究中，NM似乎与ECMO期间较少的出血并发症相关，且不增加血栓栓塞事件的发生率。
