Efficacy and Safety of Nafamostat Mesilate Injection in Patients Receiving Continuous Renal Replacement Therapy: A Meta-Analysis.
Yanting Tu, Yuanmin Hu, Qun Lv et al.
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In 30 seconds
This meta-analysis assessed the efficacy and safety of nafamostat mesilate injection versus no anticoagulation in patients receiving continuous renal replacement therapy (CRRT). It included eight studies involving 1,189 patients, with evidence derived predominantly from nonrandomized studies. Nafamostat was associated with lower mortality (OR, 0.58; 95% CI, 0.44-0.76; p < 0.001) and longer filter lifespan (MD, 7.00; 95% CI, 1.50-12.50; p = 0.01). No significant differences were observed in bleeding complications, CRRT duration, transfusion, or ICU length of stay. The authors caution that clinical benefit is not established.
Key findings
- Compared with no anticoagulation, nafamostat was associated with lower mortality (OR, 0.58; 95% CI, 0.44-0.76; p < 0.001).
- Filter lifespan was longer with nafamostat (MD, 7.00; 95% CI, 1.50-12.50; p = 0.01).
- No significant difference was found in bleeding complications (OR, 1.09; 95% CI, 0.51-2.34; p = 0.82).
- No significant differences were observed in CRRT duration, transfusion requirement, or ICU length of stay.
Why it matters
Anticoagulation during CRRT involves balancing circuit function against bleeding risk. These pooled findings suggest nafamostat may be associated with improved filter lifespan and lower mortality without a detected difference in bleeding complications. However, the evidence does not establish that nafamostat causes these outcomes, so the results should be interpreted cautiously.
What to keep in mind
The evidence was predominantly nonrandomized and was limited by small numbers of studies and substantial heterogeneity.