New approach to regional anticoagulation in hemodialysis using gabexate mesilate (FOY)

Gabexate mesilate (FOY), a synthetic serine proteinase inhibitor, prevented and controlled bleeding during hemodialysis of 3 patients with active bleeding sites and/or hemorrhagic tendencies. The effectiveness of regional anticoagulation was evaluated by activated coagulation time (ACT). The ACTs of blood sampled from the outlet of dialyzer were significantly prolonged; however, systemic ACTs were almost normal. ACTs immediately after dialysis were not prolonged compared with those before dialysis. In 1 patients, renal function was improved after dialysis. No harmful side effects of FOY were observed. We consider FOY to be superior to other drugs for hemodialysis in that: (1) it can provide sufficient regional anticoagulation; (2) it has a very short half-life and need not be antagonized after dialysis; and (3) it can be used in patients with sepsis and/or disseminated intravascular coagulation (DIC) because it inhibits proteinase and also prevents platelet aggregation.