Using nafamostat mesilate anticoagulation for continuous renal replacement therapy in high bleeding risk patients: a systematic review and meta-analysis

Objectives: The purpose of this systematic review is to evaluate the safety and efficacy of nafamostat mesilate (NM) for continuous renal replacement therapy in high bleeding risk patients. Methods: We performed a comprehensive search on PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and CNIK from inception to May 1, 2022. Two reviewers independently screened, selected, and extracted data.A meta-analysis was conducted using RevMan 5.3 software. The systematic review protocol was registered. Results: 7 studies with 639 high bleeding risk patients were included for review including 4RCTs and 3 retrospective cohort studies. The anticoagulant in the control group of all included studies was anticoagulation-free. Compared with the baseline data, the activated partial thromboplastin time of the NM group was shortened at the end of observation (MD -12.16, 95% CI -23.70 to -0.62, p= 0.04). NM for CRRTsignificantly extended filter life (MD 9.65, 95% CI 5.60 to 13.71, p< 0.00001)and reduced mortality compared with anticoagulation-free treatment (RR 0.76, 95% CI 0.64 to 0.90, p= 0.002). No significant difference was observed in the incidence of bleeding complications (RR 1.16, 95% CI 0.59 to 2.26, p= 0.67) and total duration of CRRT (MD 12.65, 95% CI -6.79 to 32.09, p= 0.20) between the groups. Subgroup analysis showed the same results except for the mortality outcome. Conclusions: For patients at high bleeding risk undergoing CRRT, NM is a better anticoagulation option. More multicenter RCTs with large samples are required to validate and compare the effects of NM anticoagulants.