Comparing the efficacy and safety of nafamostat mesylate versus citrate for anticoagulation in continuous renal replacement therapy: a systematic review and meta-analysis.
Nafamostat mesylate linked to lower bleeding risk than citrate in continuous renal replacement therapy
Comparing the efficacy and safety of nafamostat mesylate versus citrate for anticoagulation in continuous renal replacement therapy: a systematic review and meta-analysis.
Anticoagulation is pivotal to the successful implementation of continuous renal replacement therapy (continuous renal replacement therapy).
To systematically compare the efficacy and safety of nafamostat mesylate versus citrate for anticoagulation in continuous renal replacement therapy.
We performed a comprehensive literature search in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (China National Knowledge Infrastructure), Wanfang Database (Wanfang), China Science and Technology Journal Database (VIP), and China Biological Medicine Database (CBM).
nafamostat cut bleeding risk versus citrate
The meta-analysis showed no significant differences in filter lifespan or clotting events between nafamostat mesylate and citrate (MD = -0.11, 95%CI: -1.87 to 1.65, p = 0.90; RR = 0.63, 95%CI: 0.25-1.59, p = 0.33).
No significant differences were found between nafamostat mesylate and citrate in platelet (platelet), activated partial thromboplastin time (activated partial thromboplastin time), or prothrombin time (prothrombin time) (MD = 0.88, 95%CI: -5.83 to 7.59, p = 0.80; MD = -0.42, 95%CI: -2.74 to 1.91, p = 0.73; MD =-0.38, 95%CI: -1.45 to 0.68, p = 0.48).
Nafamostat mesylate suggests anticoagulant efficacy comparable to citrate in continuous renal replacement therapy, with a lower risk of bleeding, particularly in high bleeding risk situations, among patients receiving low-dose nafamostat mesylate.
For continuous renal replacement therapy patients with contraindications to citrate or high bleeding risk, nafamostat mesylate may be an anticoagulant alternative that combines efficacy with safety.
The overall certainty of the evidence from this study is low to very low; further multi-center, large-sample, high-quality randomized controlled trials are required to validate these findings.