nafamostat / Generic mfg. - LARVOL DELTA

Efficacy and safety of nafamostat mesilate in pediatric continuous renal replacement therapy: a 5-year retrospective study in South Korea. (PubMed, Child Kidney Dis) - "NM appears to be a safe anticoagulation option in pediatric CRRT patients at high bleeding risk. While overall filter life was comparable across groups, NM significantly prolonged hemofilter lifespan in patients switched from no anticoagulation, supporting its potential role as a rescue strategy."

Journal • Retrospective data • Pediatrics

Nafamostat mesylate versus low-molecular-weight heparin during continuous renal replacement therapy in critically Ill adults: a single-center retrospective cohort study. (PubMed, BMC Nephrol) - "Anticoagulant strategy was not significantly associated with circuit-related filter failure after adjustment for measured covariates. Because of substantial baseline differences, residual confounding, and limited statistical precision, these findings should not be interpreted as evidence of comparative efficacy, equivalence, noninferiority, or comparable safety. Larger prospective studies with standardized treatment protocols are needed."

Clinical • Journal • Retrospective data • Critical care

Comparison of anticoagulant and anti-inflammatory effects of nintedostat mesylate and heparin in artificial liver support system: a multicenter randomized controlled study (ChiCTR) - P=N/A | N=76 | Not yet recruiting | Sponsor: Panzhihua Central Hospital; Panzhihua Central Hospital

New trial • Hepatology • Liver Failure

Circuit Change, Peri-Change Anticoagulation and Transfusion, and Survival in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation. (PubMed, ASAIO J) - "Anticoagulants were switched from heparin to nafamostat mesylate alone or no anticoagulation (p = 0.001), and fresh-frozen plasma transfusion increased on the day of change (p = 0.016)...Circuit changes were common and occurred early after PC-ECMO initiation. Post-discharge survival was favorable among patients discharged alive."

Journal • Cardiovascular • Critical care • Heart Failure • Pediatrics

Successful management of acute respiratory distress syndrome secondary to type A aortic dissection using venovenous oxygenation: A case report. (PubMed, Perfusion) - "VV-ECMO was initiated with nafamostat anticoagulation, with temporary continuous hemodiafiltration for fluid balance. Oxygenation improved, allowing ECMO removal on Day 14. After tracheostomy, he was discharged from the ICU on Day 49 and mechanically ventilated without AD progression.DiscussionVV-ECMO can stabilize gas exchange without exacerbating AD in select patients with ARDS when perioperative risk outweighs the immediate risk of rupture or organ malperfusion.ConclusionVV-ECMO may be considered for ARDS complicated AD when the bleeding risk is mitigated by regional anticoagulation."

Journal • Acute Respiratory Distress Syndrome • Pain • Pulmonary Disease • Respiratory Diseases

Supramolecular Complexation of Niclosamide and Nafamostat: Improved Physicochemical Profile and Enhanced Anticancer Effect. (PubMed, Pharmaceuticals (Basel)) - "Furthermore, in vivo studies revealed a twofold increase in tumor growth inhibition and a tenfold reduction in total tumor burden (p < 0.05). These findings demonstrate that the NNC supramolecular crystalline phase platform successfully optimizes membrane permeability and antitumor efficacy, highlighting its potential for treating advanced cancers."

Journal • Oncology • Pancreatic Cancer • Solid Tumor

Differences in pediatric continuous renal replacement therapy initiation and prescription practices between the jpCRRT registry and the WE-ROCK cohort. (PubMed, Blood Purif) - "Contemporary pediatric CRRT practice differed between the published WE-ROCK cohort and the restricted jpCRRT cohort, particularly in terms of modality, filter type, and anticoagulation strategies. These findings suggest that pediatric CRRT practice is shaped by both regional implementation and patient case mix. Future international studies should use harmonized definitions and comparable outcome frameworks to better evaluate cross-regional differences in pediatric CRRT practice."

Journal • Critical care • Nephrology • Pediatrics • Renal Disease

Comparison of the efficacy and safety of nafamostat mesylate and heparin in blood purification therapy for patients with severe acute pancreatitis: protocol for a randomized controlled trial. (PubMed, Front Med (Lausanne)) - "The results of this study are expected to provide guidance for the selection of anticoagulant drugs for critically ill patients with severe acute pancreatitis who receive continuous renal replacement Therapy, and to clarify the optimal anticoagulation strategy for this population, thereby optimizing clinical practice for treating SAP patients. [https://clinicaltrials.gov/], identifier [ChiCTR2500 111161]."

Journal • Critical care • Hematological Disorders • Pancreatitis • Thrombocytopenia • CXCL8 • IL10 • IL6 • TNFA

Factors Influencing Unplanned Discontinuation of Continuous Renal Replacement Therapy: A Descriptive Time-Series Analysis. (PubMed, Nurs Crit Care) - "These findings provide nurses with evidence-based strategies, including locally informed monitoring protocols, standardized anticoagulation checklists and circuit pressure early warning indicators, to reduce unplanned CRRT discontinuation."

Journal • Retrospective data • Acute Kidney Injury • Nephrology • Renal Disease

Repurposed small molecule toxin inhibitors neutralise a diversity of venoms from the Neotropical viperid snake genus Bothrops. (PubMed, Elife) - "Despite variable toxin representation and bioactivity across this central and south American genus, we found that the lead inhibitors targeting metalloproteinases (marimastat and DMPS) and phospholipases (varespladib) demonstrated pan-species neutralisation in enzymatic assays, whilst nafamostat (serine protease inhibitor) had variable activity. The metalloproteinase inhibitors protected against the procoagulant and haemorrhagic effects of several venoms in phenotypic assays. Collectively these findings demonstrate that repurposed drugs may be of great value as early interventions for the treatment of bothropic envenoming in the Neotropics and thus provide a strong rationale for their progression into future preclinical and clinical evaluation for snakebite indication."

Journal

Heparin-induced thrombocytopenia with irreversible microvascular gangrene in a patient receiving venovenous-ECMO for hypervirulent Klebsiella pneumoniae sepsis. (PubMed, Intensive Crit Care Nurs) - No abstract available

Journal • Cardiovascular • Hematological Disorders • Infectious Disease • Pneumonia • Septic Shock • Thrombocytopenia • Thrombosis

Case Report: Navigating the bleeding-thrombosis paradox: regional nafamostat anticoagulation in a post-intracerebral hemorrhage patient on VV-ECMO. (PubMed, Front Med (Lausanne)) - "We hypothesize that harnessing the centrifugal pump's high-shear turbulence for homogenous drug mixing might serve as a crucial prerequisite for achieving regional anticoagulation in VV-ECMO. These findings bridge the gap between theoretical pharmacology and practical circuit engineering, offering a practical preliminary reference for the future anticoagulant management of similar high-bleeding-risk patients on ECMO."

Journal • Acute Respiratory Distress Syndrome • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Pulmonary Disease • Respiratory Diseases • Thrombosis

Nafamostat mesilate for anticoagulation in pediatric trauma patients undergoing extracorporeal membrane oxygenation: a two-center observational study in Northwest China. (PubMed, Front Med (Lausanne)) - "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). In trauma patients during ECMO support, nafamostat mesilate achieves effective anticoagulation comparable to unfractionated heparin (UFH) while significantly lowering the risk of bleeding."

Journal • Observational data • Cardiovascular • Hematological Disorders • Pediatrics • Thrombosis

Comparing the efficacy and safety of nafamostat mesylate versus citrate for anticoagulation in continuous renal replacement therapy: a systematic review and meta-analysis. (PubMed, Front Med (Lausanne)) - "The overall certainty of the evidence from this study is low to very low; further multi-center, large-sample, high-quality RCTs are required to validate these findings. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251182609, identifier CRD420251182609."

Journal • Retrospective data • Review

Effect of targeted versus fixed dosing of nafamostat mesylate on filter life in patients undergoing continuous renal replacement therapy. (PubMed, Sci Rep) - "Compared with fixed dosing, post-filter aPTT-based targeted NM dosing extended the filter life by 4.5 (95% confidence interval; 1.5-7.5) h among filters that achieved the target aPTT levels, without compromising safety issues. Further validation across diverse centers is required."

Journal • Hematological Disorders • Leukopenia

Post-marketing safety analysis of nafamostat: A retrospective pharmacovigilance study using the Japanese Adverse Drug Event Report (JADER) database. (PubMed, Medicine (Baltimore)) - "Of 6 initially detected unlabeled signals, 3 were confirmed as false-positive due to confounding bias, while the remaining 3 (bleeding complications and abnormal burning sensation) warrant clinical monitoring. Close monitoring within 24 hours after administration is highly recommended to reduce drug-related risks."

Adverse events • Journal • P4 data • Retrospective data • Allergy • Cardiovascular • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease • Pancreatitis • Respiratory Diseases • Thrombosis

Comparative efficacy and safety of anticoagulation strategies in continuous renal replacement therapy: a real-world cohort study. (PubMed, BMC Nephrol) - "In this retrospective data analysis of real-world practice, RCA provided superior filter lifespan compared to NM and UH for CRRT, while NM showed intermediate efficacy. Although major bleeding events were uncommon, the small number of events precludes definitive safety conclusions. Vigilant monitoring remains necessary regardless of the agent employed. The choice of anticoagulation should balance filter efficacy, bleeding risk, metabolic monitoring capabilities, and institutional resources."

Journal • Real-world evidence • Critical care

Discovery of potential TMPRSS2 inhibitors using integrated computational and experimental screening. (PubMed, J Mol Graph Model) - "Six candidate compounds (15, 26, 29, 31, 41, and 42) exhibited higher affinity for TMPRSS2 compared to the reference inhibitor Nafamostat (KD = 6.09 × 10-5 M)...Further mechanistic insights were gained through molecular dynamics (MD) simulations, alanine scanning mutagenesis, quantum mechanics/molecular mechanics (QM/MM) calculations, and dynamical cross-correlation matrix (DCCM) analysis, which revealed specific ligand-protein interactions in the compound 26-TMPRSS2 complex and reinforced the reliability of our findings. Collectively, these results identify compound 26 as a promising TMPRSS2-binding lead candidate, providing a solid foundation for further biochemical verification and structural optimization."

Journal • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • ERG • TMPRSS2

Development of a novel anticoagulant and fibrinolytic management monitoring method during extracorporeal circulation using clot-fibrinolysis waveform analysis: the effects of anticoagulants on coagulation and fibrinolysis functions. (PubMed, J Artif Organs) - "Nafamostat mesylate (NM), unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH) were added to normal plasma to establish each model...LMWH produced milder anticoagulant effects with minimal influence on fibrinolytic parameters.As an exploratory clinical application, CFWA was applied to a patient undergoing hemodialysis with suspected heparin resistance and recurrent circuit clotting. CFWA detected persistent hypercoagulability despite prolonged APTT after high-dose UFH administration, providing additional functional information not captured by conventional coagulation tests.CFWA may provide a sensitive and comprehensive assessment of coagulation-fibrinolysis balance and serve as a complementary monitoring tool during extracorporeal circulation."

Journal

A Novel Strategy of ECMO Management Using Nafamostat for Regional Combined With Low Intensity Systematic Anticoagulation (clinicaltrials.gov) - P=N/A | N=140 | Recruiting | Sponsor: Beijing Chao Yang Hospital | N=60 ➔ 140

Enrollment change

Hemodialysis-related allergic reactions: a retrospective cohort study of clinical presentations, etiologies, and management. (PubMed, BMC Nephrol) - "Hemodialysis-related allergic reactions are primarily attributable to hypersensitivity responses to dialyzer membranes, residual ethylene oxide in extracorporeal circuit components, and occasionally Nafamostat Mesylate administered during the procedure. Glucocorticoid administration was effective in attenuating severe anaphylactic reactions. Allergic reactions that repeatedly occur during hemodialysis may be associated with an underlying chronic micro-inflammatory state."

Journal • Retrospective data • Allergy • Chronic Kidney Disease • Dermatology • Hematological Disorders • Hypotension • Immunology • Leukopenia • Nephrology • Pruritus • Renal Disease • Thrombocytopenia • CRP

Nafamostat Mesylate Versus Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Sepsis-Associated Acute Kidney Injury (clinicaltrials.gov) - P4 | N=1162 | Not yet recruiting | Sponsor: Jianfeng Xie | Trial completion date: Jun 2028 ➔ Dec 2028

Trial completion date • Acute Kidney Injury • Infectious Disease • Nephrology • Renal Disease • Septic Shock

Risk factors for hypotension and technical complications during single-session double-filtration plasmapheresis: a 15-year retrospective study of 1,022 procedures. (PubMed, Ren Fail) - "Technical complications were independently associated with use of the PLASAUTO Σ system (OR 8.78, 95% CI 2.76-27.97), use of non-heparin/non-nafamostat anticoagulants (OR 9.42, 95% CI 2.71-32.72), and hyperviscosity syndrome (OR 8.09, 95% CI 1.80-36.29)...DFPP demonstrated an acceptable safety profile, with declining complication rates over time. The risk of complications was influenced by underlying disease, patients' status, and anticoagulation strategy."

Journal • Retrospective data • Hematological Disorders • Hypotension • Thrombocytopenic Purpura

Original research a real-world study of adverse events of nafamostat mesylate and sodium citrate based on the world health organization-VigiAccess database. (PubMed, Front Pharmacol) - "Real-world data suggested that both drugs may cause AEs that were not mentioned in the instructions, so risk management needs to be improved through dynamic pharmacological vigilance. This study provided important references for individualized selection and safety management of anticoagulation regimens for patients requiring hemodialysis."

Adverse events • Journal • Real-world evidence • Cardiovascular • Dermatology • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Movement Disorders • Muscular Atrophy • Pruritus • Pulmonary Disease • Rare Diseases • Thrombosis

Heparin-induced Thrombocytopenia During Multiple Extracorporeal Mechanical Support for Fulminant Myocarditis: A Case Report with a Literature Review. (PubMed, Intern Med) - "Heparin was replaced with nafamostat mesilate or argatroban, and HIT antibodies were detected. Both bleeding and thrombotic complications occurred during intensive care, thus reflecting the complexity of managing critically ill patients receiving multiple extracorporeal mechanical supports."

Journal • Acute Kidney Injury • Cardiovascular • Critical care • Hematological Disorders • Inflammation • Nephrology • Renal Disease • Thrombocytopenia