Case Report: Navigating the bleeding-thrombosis paradox: regional nafamostat anticoagulation in a post-intracerebral hemorrhage patient on VV-ECMO

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Nafamostat mesylate (NM) is explored for anticoagulation in ECMO patients post-intracerebral hemorrhage (ICH) to address bleeding-thrombosis dilemmas.
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Conventional NM administration at high aPTT targets poses significant bleeding risks, complicating anticoagulation strategies in post-ICH patients.
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A case study demonstrated that relocating NM infusion to the pre-pump position established effective regional anticoagulation in VV-ECMO.
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This adjustment created a significant circuit-to-systemic aPTT gradient, enabling circuit anticoagulation while minimizing systemic bleeding risks.
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The findings suggest that infusion site impacts coagulation outcomes, providing insights for managing high-bleeding-risk patients on ECMO.

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