Anticoagulation in acute blood purification for acute renal failure in critical care

The correct selection of anticoagulation in acute blood purification is crucial for avoiding exacerbation of bleeding in critical care patients with acute renal failure, as these patients frequently exhibit hemorrhagic complications. The mode of acute blood purification is determined mainly by the patient's hemodynamic stability, and continuous renal replacement therapies (CRRTs) have been extensively performed for patients with hemodynamic instability. Unfractionated heparin, low molecular weight heparin and nafamostat mesilate (nafamostat) are available in acute blood purification for the patients. Special caution should be taken when using either type of heparin in CRRT because of their antithrombin effect, long half life and large dose, and the prolonged treatment time of CRRT. This is especially the case with patients of small stature, which is the case for many Japanese people. Nafamostat can be used safely in CRRT for critical care patients with acute renal failure and bleeding risks, because it acts as a regional anticoagulant due to its pharmacological characteristics. Nafamostat has been widely used in acute blood purification at critical care units in Japan.