APPLICATION OF A NEW ANTICOAGULANT (NAFAMOSTAT MESILATE) TO CONTROL HEMORRHAGIC COMPLICATIONS DURING EXTRACORPOREAL MEMBRANE-OXYGENATION - A PRELIMINARY-REPORT

Bleeding related to systemic heparinization has been considered one of the major complications associated with extracorporeal membrane oxyge nation (ECMO). Development of the heparin-bonded system will be essent ial in reducing hemorrhagic complications, but has not yet been clinic ally proven, The authors chose an alternative approach of making a dif ference in the activated clotting time (ACT) values between the patien t and the ECMO circuit, and decreased only the patient's ACT value, wh ile keeping the value of the ECMO circuit at an ideal level. For this purpose, we have used a very short-life anticoagulant, Nafamostat Mesi late (FUT), while decreasing the dose of heparin, FUT is a synthetic p rotease inhibitor that has been found to inhibit various kinds of enzy me activities for coagulation, Twelve newborns who had some hemorrhagi c complications at various sites before or during ECMO, were selected to receive FUT The heparin dose was decreased after FUT administration into the drainage route, FUT and heparin doses were regulated to main tain the ACT value at the reinfusion route at 190 to 220 seconds. ACT values at the drainage and the reinfusion routes were simultaneously m easured. The average time on FUT was 100.3 +/- 86.3 (SD) hours. The av erage dose of FUT was 0.48 +/- 0.22 mg/kg/h, and that of heparin was 2 1.0 +/- 7.5 U/kg/h. The average ACT value at the reinfusion route was 205.7 +/- 14.0 seconds compared with that at the drainage route of 178 .5 +/- 11.8. The difference was statistically significant (P < .001). The average difference in ACT values between both routes was 27.1 +/- 7.9 seconds. The bleeding was well controlled by FUT administration in 8 of 12 cases. This report may represent the first clinical use of FU T in neonatal ECMO, and serve as a preliminary study, Copyright (C) 19 97 by W,B, Saunders Company.