Abstract
Twenty six hemodialysis (HD) patients with a high risk of bleeding were treated with nafamostat mesilate (FUT-175) as an anticoagulant. It is necessary to measure celite coagulation time (CCT) during HD to determine the optimal dose of FUT-175. As a tube applied to Actester®, which was developed for the measurement of ACT (activated coagulation time), contained celite, we thought that ACT might be useful for determining the optimal dose of FUT-175
Because the measurement of CCT is more intricate than that of ACT, we examined the correlation between ACT, CCT and coagulation time by the Lee-White method, when FUT-175 was used during HD. The dose of FUT-175 ranged from 30mg/h to 40mg/h, but one patient needed 80mg/h of FUT 175 to prolong eoagulation time in the extracorporeal circuit. We measured coagulation time by three methods at one hour after the start of HD in both the systemic circulation and extracorporeal circuit. A positive linear correlation was observed between ACT and CCT (y=18.79x+54.09, r=0.90, p<0.001), CCT and the Lee-White method (y=0.17x+1.02, r=0.88, p<0.001), and ACT and the Lee-White method (y=3.77x+60.23, r=0.84, p<0.001).
The optimal dose of FUT-175 to performed HD without risk of bleeding ranged from 20mg/h to 80mg/h; the mean dose was 35mg/h. This dose was enough to prolong coagulation time in the extracorporeal circuit without any change in coagulation time in the systemic circulation
In conclusion, the measurement of ACT by Actester® was useful to determine the optimal dose of FUT-175 to perform HD without any change in coagulation time in the systemic circulation.
