Lee Jae Ha, Park Jin Han, Jang Ji Hoon, Kim Se Hun, Hong Sung Yong, Heo Woon, Lee Dong-Hwan, Choi Hye Sook, Kim Ki Hoon, Jang Hang-Jea
Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Division of Pulmonology and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Acute Crit Care. 2022 May;37(2):177-184. doi: 10.4266/acc.2021.01312. Epub 2022 Apr 20.
Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment.
We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation.
The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group.
NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.
体外膜肺氧合（ECMO）期间通常需要进行抗凝以预防血栓形成。本研究的目的是探讨甲磺酸萘莫司他（NM）作为静脉-动脉ECMO（VA-ECMO）治疗期间局部抗凝剂的有效性。
我们回顾性分析了2017年1月至2020年6月在海云台白医院接受VA-ECMO和NM治疗的16例患者的病历。我们比较了临床和实验室数据，包括在患者和ECMO部位同时测量的活化部分凝血活酶时间（aPTT），以评估局部抗凝的效果。
患者的中位年龄为68.5岁，56.3%为男性。心血管疾病是需要ECMO治疗的最常见原发性疾病（75.0%），其次是呼吸系统疾病（12.5%）。ECMO治疗的中位持续时间为7.5天。16例患者中，7例在首次使用肝素作为抗凝剂后改用NM，9例仅接受NM治疗。比较NM组患者和ECMO部位的aPTT值，患者的aPTT值显著低于ECMO部位（73.57秒对79.25秒；P=0.010）；相比之下，肝素组未观察到差异。
与在ECMO部位测量的值相比，NM通过维持较低的aPTT值显示出作为局部抗凝方法的有效性。对于有高出血风险的患者，在VA-ECMO中，NM应被视为一种更安全的局部抗凝方法。
