Journal Article

Nafamostat mesilate as anticoagulant for blood purification: a systematic review and meta-analysis

Yang, Yingying, Li, Xu, Ren, Jinglei, Wei, Wei, Zhao, Yuliang, Huang, Yongxiu, Wang, Fang, Liu, Caihong, Tang, Xue, Fu, Ping, Zhang, Ling

2025

Overview

Objective The nafamostat mesilate (NM) has shown good safety and effectiveness as anticoagulant for blood purification. This systematic review and meta-analysis aims to comprehensively compare NM with other anticoagulation strategies during blood purification. Method We searched the electronic databases of PubMed, Web of Science, Cochrane and Embase before 6 May 2025 on the application of NM in comparison with conventional anticoagulants, including unfractionated heparin, low-molecular-weight heparin, and regional citrate, or non-anticoagulant (NA) during blood purification. The protocol was registered in PROSPERO (CRD420251110062). We compared the incidence of bleeding, clotting and mortality with risk ratio (RR) and confidence intervals (95% CIs). Mean differences (MDs) with 95% CIs were employed for the comparisons of filter life and hospitalization length. Subgroup analysis was conducted according to the specific type of conventional anticoagulants and extracorporeal modalities of blood purification. Assessment of study quality, and sensitivity and publication bias analyses were conducted. Result In total, 16 studies consisting of 4349 participants were included in this systematic review and meta-analysis. Of them, 3956 patients received renal replacement therapy, and 393 underwent extracorporeal membrane oxygenation. NM showed a significantly lower risk of bleeding (RR: 0.53, 95% CI: 0.29–0.97, P  = 0.040) and comparable filter life (MD: -1.23 h, 95% CI: -4.27–1.81, P  = 0.428) compared with conventional anticoagulants. In comparison with NA, NM demonstrated a substantially longer filter life (MD: 4.84 h, 95% CI: 0.18–9.51, P  = 0.042) and similar risk for bleeding complication (RR = 0.49, 95% CI: 0.18–1.35, P  = 0.170). Of note, it was also associated with lower in-hospital mortality compared with NA (RR: 0.87, 95% CI: 0.77–0.97, P  = 0.015). Conclusion NM is a safe and effective anticoagulant for blood purification, showing lower bleeding risk than conventional anticoagulants and longer filter life than NA, which is particularly suitable for patients at high risk of bleeding.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Anticoagulants / Anticoagulants (Medicine) / Anticoagulants - pharmacology / Anticoagulants - standards / Anticoagulants - therapeutic use / Benzamidines - pharmacology / Benzamidines - therapeutic use / Blood / Case reports / Clinical outcomes / Comparative analysis / Critical Care Medicine / Emergency Medicine / Extracorporeal membrane oxygenation / Filtration / Guanidines - pharmacology / Guanidines - therapeutic use / Handbooks / Health aspects / Hemorrhage / Humans / Intensive / Medicine / Medicine & Public Health / Meta-analysis / Metabolism / Mortality / Protease inhibitors / Renal replacement therapy / Renal Replacement Therapy - methods / Review / Systematic review