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

作者：Caihong Liu, Yingying Yang, Jinglei Ren, Yongxiu Huang, Wei Wei, Xu Li, Fang Wang, Xue Tang, Ping Fu, LH Zhang, Yuliang Zhao · 发表于：Critical Care · 年份：2025 · DOI：10.1186/s13054-025-05813-w · 被引用次数：4 · 研究领域：Atrial Fibrillation Management and Outcomes、Hemostasis and retained surgical items、Trauma, Hemostasis, Coagulopathy, Resuscitation

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 ...