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Objective <p>The nafamostat mesilate (NM) has shown good safety and effectiveness as anticoagulant for blood purification. This systematic review and meta-analysis aims to comprehensively compare NM with other anticoagulation strategies during blood purification.</p> Method <p>We searched the electronic databases of PubMed, Web of Science, Cochrane and Embase before 6 May 2025 on the application of NM in comparison with conventional anticoagulants, including unfractionated heparin, low-molecular-weight heparin, and regional citrate, or non-anticoagulant (NA) during blood purification. The protocol was registered in PROSPERO (CRD420251110062). We compared the incidence of bleeding, clotting and mortality with risk ratio (RR) and confidence intervals (95% CIs). Mean differences (MDs) with 95% CIs were employed for the comparisons of filter life and hospitalization length. Subgroup analysis was conducted according to the specific type of conventional anticoagulants and extracorporeal modalities of blood purification. Assessment of study quality, and sensitivity and publication bias analyses were conducted.</p> Result <p>In total, 16 studies consisting of 4349 participants were included in this systematic review and meta-analysis. Of them, 3956 patients received renal replacement therapy, and 393 underwent extracorporeal membrane oxygenation. NM showed a significantly lower risk of bleeding (RR: 0.53, 95% CI: 0.29–0.97, <i>P</i> = 0.040) and comparable filter life (MD: -1.23&#xa0;h, 95% CI: -4.27–1.81, <i>P</i> = 0.428) compared with conventional anticoagulants. In comparison with NA, NM demonstrated a substantially longer filter life (MD: 4.84&#xa0;h, 95% CI: 0.18–9.51, <i>P</i> = 0.042) and similar risk for bleeding complication (RR = 0.49, 95% CI: 0.18–1.35, <i>P</i> = 0.170). Of note, it was also associated with lower in-hospital mortality compared with NA (RR: 0.87, 95% CI: 0.77–0.97, <i>P</i> = 0.015).</p> Conclusion <p>NM is a safe and effective anticoagulant for blood purification, showing lower bleeding risk than conventional anticoagulants and longer filter life than NA, which is particularly suitable for patients at high risk of bleeding.</p>

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Nafamostat mesilate as anticoagulant for blood purification: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月24日

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  • Caihong Liu,
  • Yingying Yang,
  • Jinglei Ren,
  • Yongxiu Huang,
  • Wei Wei,
  • Xu Li,
  • Fang Wang,
  • Xue Tang,
  • Ping Fu,
  • Ling Zhang,
  • Yuliang Zhao

摘要

Objective

The nafamostat mesilate (NM) has shown good safety and effectiveness as anticoagulant for blood purification. This systematic review and meta-analysis aims to comprehensively compare NM with other anticoagulation strategies during blood purification.

Method

We searched the electronic databases of PubMed, Web of Science, Cochrane and Embase before 6 May 2025 on the application of NM in comparison with conventional anticoagulants, including unfractionated heparin, low-molecular-weight heparin, and regional citrate, or non-anticoagulant (NA) during blood purification. The protocol was registered in PROSPERO (CRD420251110062). We compared the incidence of bleeding, clotting and mortality with risk ratio (RR) and confidence intervals (95% CIs). Mean differences (MDs) with 95% CIs were employed for the comparisons of filter life and hospitalization length. Subgroup analysis was conducted according to the specific type of conventional anticoagulants and extracorporeal modalities of blood purification. Assessment of study quality, and sensitivity and publication bias analyses were conducted.

Result

In total, 16 studies consisting of 4349 participants were included in this systematic review and meta-analysis. Of them, 3956 patients received renal replacement therapy, and 393 underwent extracorporeal membrane oxygenation. NM showed a significantly lower risk of bleeding (RR: 0.53, 95% CI: 0.29–0.97, P = 0.040) and comparable filter life (MD: -1.23 h, 95% CI: -4.27–1.81, P = 0.428) compared with conventional anticoagulants. In comparison with NA, NM demonstrated a substantially longer filter life (MD: 4.84 h, 95% CI: 0.18–9.51, P = 0.042) and similar risk for bleeding complication (RR = 0.49, 95% CI: 0.18–1.35, P = 0.170). Of note, it was also associated with lower in-hospital mortality compared with NA (RR: 0.87, 95% CI: 0.77–0.97, P = 0.015).

Conclusion

NM is a safe and effective anticoagulant for blood purification, showing lower bleeding risk than conventional anticoagulants and longer filter life than NA, which is particularly suitable for patients at high risk of bleeding.