From the Research
Nefamostat mesylate is a synthetic serine protease inhibitor used primarily as an anticoagulant in procedures like hemodialysis and extracorporeal membrane oxygenation (ECMO), with a recommended dosage of 20-40 mg/hour for hemodialysis and 0.1-0.5 mg/kg/hour for ECMO, as supported by the most recent study 1.
Key Characteristics of Nefamostat Mesylate
- Nefamostat mesylate has a very short half-life of approximately 5-8 minutes, making it advantageous in situations requiring rapid clearance.
- Beyond its anticoagulant properties, nefamostat has shown potential as an antiviral agent and has been investigated for use in conditions like acute pancreatitis and disseminated intravascular coagulation.
- The medication works by inhibiting various proteolytic enzymes including thrombin, plasmin, and complement factors, thereby preventing blood clotting while potentially reducing inflammatory responses.
Clinical Use and Monitoring
- Regular monitoring of activated clotting time (ACT) or activated partial thromboplastin time (aPTT) is essential during administration to ensure appropriate anticoagulation levels and prevent bleeding complications.
- Studies have shown that nefamostat mesylate can be used safely and effectively in patients with high bleeding risk, with a significant reduction in the risk of bleeding complications compared to unfractionated heparin 2, 3.
Evidence-Based Recommendations
- The most recent study 1 suggests that there is no significant association between the dose of nefamostat mesylate and filter life during continuous kidney replacement therapy, highlighting the need for further research to determine the optimal dosage.
- However, based on the available evidence, nefamostat mesylate is a recommended anticoagulant for use in continuous renal replacement therapy, particularly in patients with high bleeding risk, due to its efficacy and safety profile 4, 2, 3, 5.