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Abstract Background Hepatic failure is a critical condition that frequently necessitates advanced therapeutic interventions, including extracorporeal treatments. This study aimed to evaluate the efficacy and safety of nafamostat mesylate in a double-plasma molecular adsorption system (DPMAS) compared to enoxaparin. Methods We conducted a single-center randomized controlled study. We included adult patients who required DPMAS in our department from 2021 to 2024. Clinical and filter-related data were extracted. Results We included 30 patients in the study, with 16 in the MN group and 14 in the Enoxaparin group. The MN group received an average dosage of 92.75 ± 6.28 mg, whereas the Enoxaparin group received 3214.29 ± 892.58 IU. Use of MN was associated with a lower risk of bleeding complications at the puncture site (6.25% vs. 28.57%, P = 0.037). Both groups showed significant reductions in total bilirubin levels post-treatment (MN: 139.12 ± 34.69 µmol/L, Enoxaparin: 135 ± 16.61 µmol/L), with no significant difference between the groups. There were no significant differences between the groups in terms of dialyzer coagulation, hypotension, red blood cell transfusion, or 30- and 90-day survival rates (P > 0.05). Conclusions The use of NM as an anticoagulant during DPMAS was associated with a decreased incidence of bleeding complications compared to the use of enoxaparin. NM is a safe and effective anticoagulant for DPMAS treatment in hepatic failure patients.
Hu et al. (Wed,) studied this question.