Effects of intermittent nafamostat mesylate in divided doses in patients with disseminated intravascular coagulation occurring with hematopoietic malignancies

Abstract In this uncontrolled, unblinded efficacy study, 33 patients with disseminated intravascular coagulatoin (DIC) or the prodromal stage (preDIC) of the condition were treated with nafamostat mesylate (NM) administered intermittently to examine whether this regimen would be as efficacious as the standard regimen without causing an increase in drug toxicity. Efficacy was evaluated on the basis of the results of coagulation studies and on improvement in the DIC score, which was calculated by adding the points of the underlying diseases, clinical symptoms, prothrombin ratio, fibrinogen, and fibrin degradation product (FDP)-E fraction. A score of 3 points was categorized as preDIC, and 4 or more as DIC. In Japan, the FDP-E fraction is often measured as a substitute for FDP because the value of the FDP-E fraction changes in a wider range and shows more sensitive responses than FDP. NM is usually given by 24-hour continuous administration; in this study, NM was infused intermittently at a daily dose of 90 to 150 mg intravenously to avoid hyperkalemia. Each infusion lasted 4 hours, and the interval between administrations was 2.95 ± 0.19 hours. After 7 days of treatment, the mean DIC score decreased significantly from 3.9 ± 0.1 to 2.0 ± 0.2 ( P P P