Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China.
The Intensive Care Unit, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Ren Fail. 2022 Dec;44(1):1263-1279. doi: 10.1080/0886022X.2022.2105233.
Nafamostat mesilate (NM), a broad-spectrum and potent serine protease inhibitor, can be used as an anticoagulant during extracorporeal circulation, as well as a promising drug effective against coronavirus disease 2019 (COVID-19). We conducted a systematic meta-analysis to evaluate the safety and efficacy of NM administration in critically ill patients who underwent blood purification therapy (BPT).
The Cochrane Library, Web of Science and PubMed were comprehensively searched from inception to August 20, 2021, for potential studies.
Four randomized controlled trials (RCTs) and seven observational studies with 2723 patients met the inclusion criteria. The meta-analysis demonstrated that conventional therapy (CT) significantly increased hospital mortality compared with NM administration (RR = 1.25, = 0.0007). In subgroup analyses, the in-hospital mortality of the NM group was significantly lower than that of the anticoagulant-free (NA) group (RR = 1.31, = 0.002). The CT interventions markedly elevated the risk ratio of bleeding complications by 45% (RR = 1.45, = 0.010) compared with NM interventions. In another subgroup analysis, NM used exhibited a significantly lower risk of bleeding complications than those of the low-molecular-weight heparin (LMWH) used (RR = 4.58, = 0.020). The filter lifespan was decreased significantly (MD = -10.59, < 0.0001) in the NA groups compared with the NM groups. Due to the poor quality of the included RCTs, these results should be interpreted with caution.
Given the better survival outcomes, lower risk of bleeding, NM anticoagulation seems to be a safe and efficient approach for BPT patients and could yield a favorable filter lifespan. More multi-center RCTs with large samples are required for further validation of this study.
甲磺酸萘莫司他（NM）是一种广谱且强效的丝氨酸蛋白酶抑制剂，可用作体外循环抗凝剂，也是治疗 2019 年冠状病毒病（COVID-19）的有前途的有效药物。我们进行了一项系统的荟萃分析，以评估在接受血液净化治疗（BPT）的危重症患者中使用 NM 的安全性和疗效。
从建库到 2021 年 8 月 20 日，全面检索了 Cochrane 图书馆、Web of Science 和 PubMed 以寻找潜在的研究。
四项随机对照试验（RCT）和七项观察性研究共纳入 2723 例患者。荟萃分析表明，常规治疗（CT）与 NM 给药相比显著增加了住院死亡率（RR=1.25， = 0.0007）。在亚组分析中，NM 组的住院死亡率明显低于无抗凝剂（NA）组（RR=1.31， = 0.002）。CT 干预使出血并发症的风险比显著增加了 45%（RR=1.45， = 0.010），与 NM 干预相比。在另一个亚组分析中，与使用低分子量肝素（LMWH）相比，NM 的出血并发症风险显著降低（RR=4.58， = 0.020）。NA 组的滤器寿命明显缩短（MD=-10.59， < 0.0001）。由于纳入的 RCT 质量较差，因此应谨慎解释这些结果。
鉴于更好的生存结果，较低的出血风险，NM 抗凝似乎是 BPT 患者安全有效的方法，并且可以获得有利的滤器寿命。需要更多的多中心 RCT 来进一步验证本研究。
