The Impact of Nafamostat Mesylate on the Prognosis of Patients With Sepsis-Induced Coagulopathy Undergoing Hemofiltration

Jilin University

Status: Not yet enrolling

Conditions: Sepsis-induced Coagulopathy (SIC)

Treatments: Drug: Nafamostat Mesylate; Drug: sodium citrate

Study type: Interventional

Funder types: Other

Identifiers

NCT06994312

Yuting Li 20250430

Details and patient eligibility

About

In sepsis, the body is prone to coagulation system disorders, which may progress to sepsis-induced coagulopathy (SIC). When SIC is persistent and cannot be corrected, it often sequentially develops into disseminated intravascular coagulation (DIC) with multiple organ failure. Nafamostat mesylate can be used as an anticoagulant during blood purification in critically ill patients and is also used to treat SIC.Safe and effective anticoagulation is a prerequisite for the success of blood purification therapy. For patients with active bleeding or at risk of bleeding, how to achieve extracorporeal anticoagulation without affecting the body's coagulation function is a major clinical challenge. Nafamostat mesylate can reduce the risk of bleeding during blood purification, but its impact on the survival outcomes of patients with SIC undergoing blood purification therapy remains unclear.The aim of this study is to evaluate the impact of nafamostat mesylate treatment on the prognosis of patients with sepsis-induced coagulopathy undergoing hemofiltration.

Enrollment: 282 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults (Age ≥ 18 years);
• Patients with SIC Undergoing Hemofiltration.

Exclusion criteria

• Individuals under the age of 18, pregnant women, and breastfeeding mothers;
• Patients with a history of high sensitivity to nafamostat mesylate (those who have experienced significant bleeding complications from previous use of nafamostat mesylate);
• Fibrinogen < 1.5 g/L;
• Patients with bleeding or high risk of bleeding:

Those in the acute phase of trauma or with active bleeding (e.g., flail chest, obvious contusions of the lungs, liver, spleen, retroperitoneal bleeding, pelvic fractures, etc.); Those with a history of severe head trauma, intracranial surgery, stroke, cerebral aneurysm, or arteriovenous malformation within one month prior to enrollment; Those with a history of congenital bleeding disorders: such as hemophilia; Those with underlying fulminant hepatitis, decompensated cirrhosis, or other severe liver diseases.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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282 participants in 2 patient groups

Nafamostat Mesylate Group

Experimental group

Description:

Nafamostat mesylate (50 mg/vial, Jiangsu DuRui Pharmaceutical Co., Ltd.) is dissolved and prepared with 5% glucose injection solution. It is continuously infused through the anticoagulant injection tube at the start of hemofiltration, with an initial dose generally ranging from 20 to 50 mg/h. Monitoring is performed before treatment and within 2 to 4 hours after the start of treatment. In cases of active bleeding, moderate to high bleeding risk, hypercoagulable state, or high-dose use of nafamostat mesylate (NM), the monitoring frequency should be increased (e.g., every 4 to 6 hours). After the treatment becomes stable, the monitoring interval can be extended to 12 to 24 hours. The activated clotting time (ACT) or activated partial thromboplastin time (APTT) at the post-dialyzer or venous end should be maintained at 1.5 to 2.5 times the pre-treatment level, or the ACT should be maintained between 150 and 250 seconds, and the APTT between 50 and 70 seconds.

Treatment:

Drug: Nafamostat Mesylate

Sodium Citrate Group

Active Comparator group

Description:

Patients were continuously infused with sodium citrate (200 ml/bag, Chengdu Qingshanlikang Pharmaceutical Co., Ltd.). The initial pump rate of 4% sodium citrate was set at 2.1% of the blood flow rate, and the initial pump rate of 10% calcium gluconate was set at 7.3% of the flow rate of 4% sodium citrate. Adjust the doses of sodium citrate and calcium gluconate based on the levels of ionized calcium in arterial and venous blood gases.The goal is to maintain arterial blood ionized calcium levels at 1.00-1.20 mmol/L and venous blood ionized calcium levels at 0.21-0.40 mmol/L.

Treatment:

Drug: sodium citrate