Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Validation of Nafamostat Mesilate as an Anticoagulant in Extracorporeal Membrane Oxygenation: A Large-Animal Experiment

  • Han, Sung Joon (Department of Thoracic and Cardiovascular Surgery, Chungnam National University School of Medicine) ;
  • Han, Woosik (Department of Thoracic and Cardiovascular Surgery, Chungnam National University School of Medicine) ;
  • Song, Hee-Jung (Department of Neurology, Chungnam National University School of Medicine) ;
  • Kim, Cuk-Seong (Department of Physiology, Chungnam National University School of Medicine) ;
  • Jeong, Seong-Mok (Department of Veterinary Medicine, Chungnam National University School of Medicine) ;
  • Kang, Min Woong (Department of Thoracic and Cardiovascular Surgery, Chungnam National University School of Medicine)
  • Received : 2017.08.29
  • Accepted : 2017.10.20
  • Published : 2018.04.05
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Abstract

Background: Unfractionated heparin is commonly used for anticoagulation in extracorporeal membrane oxygenation (ECMO). Several studies have shown that nafamostat mesilate (NM) has comparable clinical outcomes to unfractionated heparin. This study compared anticoagulation with NM and heparin in a large-animal model. Methods: Beagle dogs (n=8; weight, 6.5-9 kg) were placed on venovenous ECMO. Blood samples were taken every hour and the following parameters were compared: hemoglobin level, activated partial thromboplastin time (aPTT), thromboelastography (TEG) data, platelet function, and inflammatory cytokine levels. Results: In both groups, the aPTT was longer than the baseline value. Although the aPTT in the NM group was shorter than in the heparin group, the TEG parameters were similar between the 2 groups. Hemoglobin levels decreased in both groups, but the decrease was less with NM than with heparin (p=0.049). Interleukin $(IL)-1{\beta}$ levels significantly decreased in the NM group (p=0.01), but there was no difference in the levels of tumor necrosis factor alpha or IL-10 between the 2 groups. Conclusion: NM showed a similar anticoagulant effect to that of unfractionated heparin, with fewer bleeding complications. NM also had anti-inflammatory properties during ECMO. Based on this preclinical study, NM may be a good alternative candidate for anticoagulation in ECMO.

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References

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