Nafamostat mesilate for anticoagulation in pediatric trauma patients undergoing extracorporeal membrane oxygenation: a two-center observational study in Northwest China.

BACKGROUND

In recent years, accidental injury has emerged as a leading cause of mortality in the pediatric population. Such trauma frequently induces severe damage to parenchymal organs as a result of significant external mechanical force. In severe cases, death may occur rapidly when impaired cardiopulmonary function cannot be adequately sustained. Extracorporeal membrane oxygenation (ECMO) plays a critical role in supporting these patients. However, the selection of an anticoagulation strategy remains a decisive factor influencing clinical outcomes. This study aims to evaluate the comparative efficacy of regional anticoagulation using nafamostat mesilate vs. systemic anticoagulation with unfractionated heparin in pediatric patients with trauma undergoing extracorporeal membrane oxygenation (ECMO) support.

METHODS

In this study, 40 patients hospitalized due to severe trauma and received ECMO assistance were selected as the research subjects. According to the anticoagulation protocol, the patients were divided into the nafamostat mesilate group and the unfractionated heparin (UFH) group. Demographic data, hematological profiles, and coagulation parameters were systematically compared at baseline, 24, and 72 h after admission in patients receiving ECMO support. Clinical outcomes were evaluated based on the following criteria: transfusion requirements, use of coagulation-related agents, incidence of complications, and successful removal. The SPSS 21.0 statistical software was utilized for data statistics.

RESULTS

A total of 40 patients were enrolled in this study, 24 cases in the nafamostat mesilate group and 16 cases in the UFH group. There was no statistically significant difference in characteristics of blood cell classification and coagulation-related laboratory parameters at admission. Compared with the nafamostat mesilate group, the UFH group exhibited a higher rate of new-onset active bleeding, circuit thrombosis, and this difference was statistically significant (P < 0.05). In the UFH group, the incidence of mandatory anticoagulant discontinuation was significantly higher than that in the nafamostat mesilate group, attributable to a greater volume of active bleeding. Subgroup analysis patients who underwent surgery, new-onset active bleeding occurred in two of eight patients in the nafamostat mesilate group, with no interruption of anticoagulation, whereas severe new-onset active bleeding occurred in six of nine patients in the UFH group, requiring discontinuation of anticoagulation (all P < 0.05).

CONCLUSION

In trauma patients during ECMO support, nafamostat mesilate achieves effective anticoagulation comparable to unfractionated heparin (UFH) while significantly lowering the risk of bleeding.