Abstract: Objective This clinical trial was conducted to compare anticoagulational effect of nafamostat mesylate (NM) and unfractionated heparin (UFH) during double plasma molecular adsorption system (DPMAS) treatment in patients with liver failure(LF). Methods We retrospectively analyzed clinical materials of LF patients underwent DPMAS treatment in Department of Gastroenterology, Shanxi Bethune Hospital between May 2023 and May 2024. During the procedure, NM as an anticoagulant was given at dose of 60 mg for piping with thereafter 35 mg.h^-1 maintaining. Prothrombin time activity(PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT) and blood platelet counts were routinely detected. Results 27 patients with LF were enrolled and received 62 times of DPMAS treatments, of which UFH was used in 21 times and NM was used in 41 times; after DPMAS treatment, elongation APTT and INR in NM group were 1.3(-3.6, 9.0)% and 2.5(-8.5, 16.6)%, both significantly less than [271.1(49.0, 816.5)% and 68.9(44.8, 118.8)%, respectively, P<0.05] in UFH group, and reduction rates of PTA and PLT counts were (4.2±23.7)% and 4.6(1.3, 7.6)%, both significantly lower than [(46.5±24.3)% and (13.0±12.6)%, respectively, P<0.05] in UFH group; there was no significant difference as respect to incidences of hypotension (9.8% vs. 14.3%, P>0.05), and no bleeding was found between the two groups. Conclusion Impact of nafamostat mesylate on coagulation function tests and platelet counts in patients with LF during DPMAS treatment is relatively small, and needs further clinical investigation as a limited cases observed.

Key words: Liver failure, Dual plasma molecular adsorption system, Nafamostat mesylate, Unfractionated heparin, Anticoagulation