Journal of Veterinary Emergency and Critical Care 28(2) 2018, pp 122–129
Evaluation of nafamostat mesilate as an
alternative anticoagulant during intermittent
hemodialysis in healthy Beagle dogs
Joon-hyuk Choi, DVM, MS; Seok-yeong Byun, DVM, MS; Aryung Nam, DVM;
Sei-myoung Han, DVM, PhD; Kyu-pil Lee, DVM, PhD; Kun-ho Song, DVM, PhD;
Hwa-young Youn, DVM, PhD and Kyoung-won Seo, DVM, PhD
Objective – To evaluate nafamostat mesilate (NM) as an alternative anticoagulant agent for intermittent
Design – Prospective randomized study.
Setting – University teaching hospital.
Animals – Eighteen healthy Beagle dogs.
Interventions –Ingroup1(n = 6), NM was administered at a dose of 0.5 mg/kg/h during IHD for 5 hours. In
group 2 (n = 6), NM was administered at a low dose of 0.25 mg/kg/h during IHD. In group 3 (n = 6), which
was the control group, unfractionated heparin (UFH) was administered during IHD. The evaluated parameters
included: the amount of residual blood clots in the blood chamber and arterial side of the dialyzer; the levels
of hemoglobin, hematocrit, and platelets; and the prothrombin time (PT), activated partial thromboplastin time
(aPTT), and activated clotting time (ACT).
Measurements and Main Results – Groups 1 and 2 successfully completed IHD without serious coagulation in
the extracorporeal circulation. The residual blood clotting in the blood chamber and arterial side of the dialyzer
did not signiﬁcantly differ in groups 1 and 2 compared to group 3 (group 1 vs group 3, P = 1.000; and group 2
vs group 3, P = 1.000). No signiﬁcant differences were observed between pre- and posttreatment PTs in groups
1(P = 0.476) and 2 (P = 0.597), between pre- and posttreatment aPTTs in groups 1 (P = 0.983) and 2 (P = 0.977),
and between pre- and posttreatment ACT in groups 1 (P = 0.282) and 2 (P = 0.401). In group 3, a signiﬁcant
elevation of ACT was observed at the posttest (P < 0.001).
Conclusions – The results of this study in healthy Beagle dogs suggest that NM at 0.25 mg/kg/h may be a valid
alternative to UFH for IHD. Further studies are needed in patients at high risk of bleeding.
(J Vet Emerg Crit Care 2018; 28(2): 122–129) doi: 10.1111/vec.12696
anticoagulation, canine, dialysis, extracorporeal therapy, kidney injury, unfractionated heparin
ACT activated clotting time
aPTT activated partial thromboplastin time
CRRT continuous renal replacement therapy
From the Laboratory of Veterinary Internal Medicine (Choi, Byun, Song,
Seo); the Laboratory of Veterinary Physiology (Lee), College of Veterinary
Medicine, Chungnam National University, Daejeon 305-764, South Korea;
and the Laboratory of Veterinary Internal Medicine, College of Veterinary
Medicine Seoul National University, Seoul, South Korea (Nam, Han, Youn).
The authors declare no conﬂict of interest.
Address correspondence and reprint requests to
Prof. Kyoung-won Seo, Department of Veterinary Internal Medicine, Col-
lege of Veterinary Medicine, Chungnam National University, Gung-dong,
Yuseong-gu, Daejeon 305-764, South Korea.
Submitted July 23, 2015; Accepted May 18, 2016.
ECC extracorporeal circulation
HIT heparin-induced thrombocytopenia
IHD intermittent hemodialysis
LMWH low molecular weight heparin
NM nafamostat mesilate
PT prothrombin time
blood ﬂow rate
dialysate ﬂow rate
UFH unfractionated heparin
Anticoagulation is required to prevent thrombosis when
using extracorporeal circulation (ECC). Unfractionated
Veterinary Emergency and Critical Care Society 2018