This meta-analysis included 17 studies involving 1,893 patients, comparing nafamostat with sodium citrate, unfractionated heparin, or no anticoagulation during ECMO/CRRT. Nafamostat was associated with fewer bleeding events (odds ratio 0.61; 95% confidence interval 0.43–0.86). Filter lifespan did not differ significantly between groups (mean difference 1.29 hours; 95% confidence interval −1.09 to 3.66). A separate FAERS analysis included 24,238 reports across the three anticoagulants and identified nafamostat reporting signals for disseminated intravascular coagulation, gastrointestinal hemorrhage, and decreased platelet count; these are reporting signals rather than comparative clinical risks.
The pooled bleeding association is relevant to extracorporeal-support care, but does not establish an ECMO-specific benefit. Nonsignificant filter-lifespan findings do not demonstrate equivalence.
Study limitation: The abstract does not separate ECMO from CRRT results or report mortality findings, limiting cardiac ICU interpretation.
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