Document Detail

Superior outcome of nafamostat mesilate as an anticoagulant in patients undergoing maintenance hemodialysis with intracerebral hemorrhage.
MedLine Citation:
PMID:  19814633     Owner:  NLM     Status:  MEDLINE    
AIMS: The incidence of complications associated with cerebrovascular diseases in patients who receive hemodialysis for a long-term period is higher than that of other complications. It is known that mortality due to cerebral hemorrhage is two times higher compared to non-dialysis patients. Anti-coagulants used for hemodialysis are essential. Accordingly, in cases in which the cerebral hemorrhage occurred, the selection of anti-coagulants for the prevention of further bleeding poses a great challenge to physicians. The change of hematoma and patient prognosis has a direct relationship. Many ongoing studies are conducted to examine the causative factors causing the increased hematoma and their related prognostic factors. In the current study, we examined the effect of nafamostat mesylate (a serine protease inhibitor) on the change of hematoma compared to heparin in hemodialysis patients. METHODS: The current study was conducted in 17 hemodialysis patients who developed a cerebral hemorrhage. These patients were assigned to two groups based on the type of anti-coagulants that they used (i.e., nafamostat mesylate and heparin). Then, the factors affecting the change of hematoma following the onset of cerebral hemorrhage were examined. The prognosis of hematoma was assessed based on brain CT scans, which were performed two weeks after the onset of cerebral hemorrhage in four groups. Following this, groups 1 (the decreased hematoma) and 2 (the decreased delay) were merged to group A (resolving group), and groups 3 (the increased hematoma) and 4 (the death following the aggravation) were merged to group B (the expansion group) for further analysis. RESULTS: There were no significant differences in baseline characteristics between the nafamostat group and the heparin group. A comparison between the resolving group and the expansion group also showed that there were no significant differences in baseline characteristics. In the anti-coagulants and the change of hematoma, however, there were significant differences between the two groups (p = 0.024). A comparison of the change of hematoma between the four groups was also made. This showed that platelet counts and BUN level were significant factors (Platelet; p = 0.042, BUN; p = 0.043 ANOVA with resolving group). CONCLUSIONS: Nafamostat mesylate has a similar profile of anti-coagulative activity to heparin. It is assumed, however, that nafamostat has an affirmative effect on the recovery of damaged sites following the onset of cerebral hemorrhage. It is an anti-coagulant that can be safely used for hemodialysis following the onset of cerebral hemorrhage.
Jae Won Yang; Byoung Geun Han; Bi Ro Kim; Yo Han Lee; Young Sub Kim; Jong Myeong Yu; Seung Ok Choi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Renal failure     Volume:  31     ISSN:  1525-6049     ISO Abbreviation:  Ren Fail     Publication Date:  2009  
Date Detail:
Created Date:  2009-10-09     Completed Date:  2010-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701128     Medline TA:  Ren Fail     Country:  England    
Other Details:
Languages:  eng     Pagination:  668-75     Citation Subset:  IM    
Department of Internal Medicine, Yonsei University Wonju College of Medicine.
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MeSH Terms
Anticoagulants / administration & dosage*
Cerebral Hemorrhage / complications*
Guanidines / administration & dosage*
Kidney Failure, Chronic / complications,  therapy*
Middle Aged
Renal Dialysis*
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Guanidines; 81525-10-2/nafamostat

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