A case involving the use of nafamostat mesilate as an anticoagulant during extracorporeal membrane oxygenation in acute myocardial infarction

It is essential during extracorporeal membrane oxygenation (ECMO) to extend the activated clotting time (ACT) using anticoagulants to prevent blood clot formation. Traditionally, heparin has been used as an anticoagulant during ECMO. Hemorrhaging due to systemic heparinization is considered a major complication of ECMO. A 48-year-old man was admitted due to cardiogenic shock with acute myocardial infarction. ECMO was instituted because of recurrent ventricular tachycardia and refractory shock. We used nafamostat mesilate (Futhan) as an anticoagulant to reduce hemorrhagic complications. The total bypass time was 153 h. The average dose of nafamostat mesilate was 2.64±1.11 mg/kg/h; the average ACT was 128.68±21.24 seconds. Only a few units were transfused, and there was no oxygenator failure or hemorrhagic complications. Thus, nafamostat mesilate may reduce the need for transfusions and hemorrhagic complications during ECMO. (Korean J Med 79:181-186, 2010)