Clinical Scorecard: Clinical Case Study: Addressing the Bleeding-Thrombosis Dilemma with Regional Nafamostat Anticoagulation in a VV-ECMO Patient Post-Intracerebral Hemorrhage

At a Glance

Key Highlights

• Nafamostat mesylate (NM) was used for anticoagulation in a post-ICH patient on VV-ECMO.
• Initial NM infusion at the post-pump site failed to achieve regional anticoagulation.
• Relocating NM infusion to the pre-pump position established effective circuit anticoagulation.
• The strategy minimized systemic bleeding risk while managing circuit thrombosis.
• This case highlights the importance of infusion site in achieving desired anticoagulation outcomes.

Guideline-Based Recommendations

Diagnosis

• Monitor for signs of recurrent intracerebral hemorrhage in post-ICH patients.

Management

• Consider nafamostat mesylate for anticoagulation in high-bleeding-risk patients on ECMO.

Monitoring & Follow-up

• Regularly assess activated partial thromboplastin time (aPTT) to guide anticoagulation therapy.

Risks

• Be aware of the risk of circuit thrombosis and systemic bleeding when managing anticoagulation.

Patient & Prescribing Data

Post-ICH patients requiring ECMO support.

Ultra-low systemic targets for NM may help balance bleeding and thrombosis risks.

Clinical Best Practices

• Utilize a multidisciplinary approach when managing anticoagulation in high-risk patients.
• Optimize infusion site for anticoagulants to enhance efficacy and safety.

Related Resources & Content

• Clinical Case Study