Cardiac arrest caused by nafamostat mesilate

Area of Science:

• Nephrology
• Anesthesiology
• Clinical Pharmacology

Background:

• Hemodialysis is a critical treatment for kidney failure.
• Anticoagulants are essential during hemodialysis to prevent circuit clotting.
• Nafamostat mesilate is used as an anticoagulant, particularly when bleeding is a concern.

Purpose of the Study:

• To report a rare case of anaphylactic shock induced by nafamostat mesilate during hemodialysis.
• To highlight the importance of recognizing and managing adverse drug reactions in nephrology patients.

Main Methods:

• A 65-year-old male patient undergoing hemodialysis experienced cardiac arrest.
• Nafamostat mesilate was used as an anticoagulant, and later, anaphylactic symptoms developed upon re-administration.
• Diagnostic tests included total immunoglobulin E titer and skin prick testing for nafamostat mesilate.

Main Results:

• The patient suffered cardiac arrest during initial hemodialysis with nafamostat mesilate.
• Upon re-exposure, the patient exhibited anaphylactic signs including dyspnea, hypotension, and facial swelling.
• Allergy testing confirmed weak positivity for nafamostat mesilate, indicating an allergic reaction.

Conclusions:

• Nafamostat mesilate can cause anaphylactic shock in hemodialysis patients.
• Early recognition and appropriate management are crucial for patient safety.
• This is the first reported case of nafamostat mesilate-induced anaphylactic shock in Korea.