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<p>Systemic anticoagulation with unfractionated heparin (UFH) is the standard of care during extracorporeal membrane oxygenation (ECMO). However, in patients with coagulation disorders or high bleeding risk, UFH may lead to life-threatening hemorrhage. To evaluate the safety and feasibility of a combined anticoagulation strategy using circuit-directed (pre-oxygenator) nafamostat mesilate and low-dose systemic UFH in selected high bleeding-risk ECMO patients. We conducted a retrospective case series of 8 adult ECMO patients with coagulopathy between January 2023 and December 2024 at a tertiary ICU. Patients received continuous pre-oxygenator nafamostat mesilate (0.5–0.75&#xa0;mg/kg/h) and low-dose systemic UFH (4–8 U/kg/h), guided by predefined activated clotting time (ACT) and activated partial thromboplastin time (APTT) targets. No oxygenator exchange for circuit thrombosis or confirmed systemic thromboembolic events were observed. Three patients experienced minor bleeding (37.5%), and no major hemorrhage occurred. ACT and APTT measurements were generally within protocol-defined target ranges. In this descriptive case series, circuit-directed nafamostat combined with low-dose systemic UFH appeared feasible in selected high bleeding-risk ECMO patients. Controlled comparative studies are needed to determine effectiveness, optimal monitoring, and safety.</p> Graphical Abstract <p></p>

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Combined circuit-directed (pre-oxygenator) nafamostat and low-dose systemic unfractionated heparin anticoagulation in ecmo patients with high bleeding risk: A case series and safety evaluation

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Yunjiu Hu,
  • Shihui Lin,
  • Mu Zhang,
  • Lin Ye,
  • Zhijiao Zhang,
  • Jing Fan,
  • Fang Xu

摘要

Systemic anticoagulation with unfractionated heparin (UFH) is the standard of care during extracorporeal membrane oxygenation (ECMO). However, in patients with coagulation disorders or high bleeding risk, UFH may lead to life-threatening hemorrhage. To evaluate the safety and feasibility of a combined anticoagulation strategy using circuit-directed (pre-oxygenator) nafamostat mesilate and low-dose systemic UFH in selected high bleeding-risk ECMO patients. We conducted a retrospective case series of 8 adult ECMO patients with coagulopathy between January 2023 and December 2024 at a tertiary ICU. Patients received continuous pre-oxygenator nafamostat mesilate (0.5–0.75 mg/kg/h) and low-dose systemic UFH (4–8 U/kg/h), guided by predefined activated clotting time (ACT) and activated partial thromboplastin time (APTT) targets. No oxygenator exchange for circuit thrombosis or confirmed systemic thromboembolic events were observed. Three patients experienced minor bleeding (37.5%), and no major hemorrhage occurred. ACT and APTT measurements were generally within protocol-defined target ranges. In this descriptive case series, circuit-directed nafamostat combined with low-dose systemic UFH appeared feasible in selected high bleeding-risk ECMO patients. Controlled comparative studies are needed to determine effectiveness, optimal monitoring, and safety.

Graphical Abstract