{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:06:02Z","timestamp":1791043562991,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T00:00:00Z","timestamp":1652054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Extracorporeal membrane oxygenation (ECMO) represents an advanced option for supporting refractory respiratory and\/or cardiac failure. Systemic anticoagulation with unfractionated heparin (UFH) is routinely used. However, patients with bleeding risk and\/or heparin\u2010related side effects may necessitate alternative strategies: among these, nafamostat mesilate (NM) has been reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic literature search (PubMed and EMBASE, updated 12\/08\/2021), including all studies reporting NM anticoagulation for ECMO. We focused on reasons for starting NM, its dose and the anticoagulation monitoring approach, the incidence of bleeding\/thrombosis complications, the NM\u2010related side effects, ECMO weaning, and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The search revealed 11 relevant findings, all with retrospective design. Of these, three large studies reported a control group receiving UFH, the other were case series (<jats:italic>n<\/jats:italic>\u00a0=\u00a03) or case reports (<jats:italic>n<\/jats:italic>\u00a0=\u00a05). The main reason reported for NM use was an ongoing or high risk of bleeding. The NM dose varied largely as did the anticoagulation monitoring approach. The average NM dose ranged from 0.46 to 0.67\u2009mg\/kg\/h, but two groups of authors reported larger doses when monitoring anticoagulation with ACT. Conflicting findings were found on bleeding and thrombosis. The only NM\u2010related side effect was hyperkalemia (<jats:italic>n<\/jats:italic>\u00a0=\u00a02 studies) with an incidence of 15%\u201318% in patients anticoagulated with NM. Weaning and survival varied across studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Anticoagulation with NM in ECMO has not been prospectively studied. While several centers have experience with this approach in high\u2010risk patients, prospective studies are warranted to establish the optimal space of this approach in ECMO.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14276","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T09:34:38Z","timestamp":1652088878000},"page":"2371-2381","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Use of nafamostat mesilate for anticoagulation during extracorporeal membrane oxygenation: A systematic review"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5144-0776","authenticated-orcid":false,"given":"Filippo","family":"Sanfilippo","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care A.O.U. \u201cPoliclinico\u2010San Marco\u201d  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica 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