ABSTRACT
Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Subject(s)
Female , Humans , Male , Middle Aged , Acute Disease , Anticoagulants/administration & dosage , Dose-Response Relationship, Drug , Extracorporeal Membrane Oxygenation , Guanidines/administration & dosage , Heart Failure/diagnosis , Heparin/administration & dosage , Myocardial Infarction/diagnosis , Respiratory Distress Syndrome/diagnosis , Retrospective Studies , Shock, Septic/diagnosis , Survival AnalysisABSTRACT
Se estudió el efecto hipotensor de una droga de acción bloqueadora adrenérgica neuronal (bethanidine) en asociación con propranolol y furosemida; estas últimas a dosis fijas pre y durante la instauración del tratamientos, en 14 pacientes hipertensos esenciales (HTAE) severos, alguno de los cuales tenía insuficiencia renal crónica, ligera y moderada. El período de estudio fue de 3 meses con dosis de bethanidine entre 20 y 80mg/d (promedios de 40,0 + ou - 14,14 a 54,28 + ou - 18 mg/d). Se controló por completo la presión arterial en el 85,7% (12/14) de los pacientes y en los restantes 14,3% se obtuvo un control parcial. La hipotensión postural, aunque frecuente, fue bien tolerada y desapareció rápidamente con reducción de la dosis. Se plantea que la asociación de bethanidine con propranolol y furosemida es adecuada para el tratamientos de la HTAE severa, de difícil control con los tratamientos clásicos