Why the study?
Achieving an optimal balance between thrombosis prevention and bleeding risk during temporary mechanical circulatory support remains a significant clinical challenge.
Does nafamostat mesilate provide safe and effective anticoagulation during Impella support in patients with advanced heart failure and cardiogenic shock?
Does nafamostat mesilate provide safe and effective anticoagulation during Impella support in patients with advanced heart failure and cardiogenic shock?
Nafamostat mesilate may serve as a feasible alternative anticoagulant during Impella support, though careful monitoring for hyponatremia is required.
May support NM as alternative anticoagulation in select Impella cases; leaves open need for prospective trials before wider use.
Achieving an optimal balance between thrombosis prevention and bleeding risk during temporary mechanical circulatory support remains a significant clinical challenge. Effective anticoagulation management that ensures device functionality while minimizing major bleeding events should have the potential to improve short-term outcomes. Here, we report the successful use of nafamostat mesilate (NM) as an anticoagulant during Impella support in two male patients with advanced heart failure and cardiogenic shock. NM therapy resulted in improved thrombocytopenia without the occurrence of major bleeding or thrombotic events. However, NM-related hyponatremia was observed, highlighting the need for careful monitoring during its administration and further cumulative evidence to validate optimal NM therapy during temporary mechanical circulatory supports.
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Nakamura et al. (2025) studied this question.
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