Comparison of regional citrate anticoagulation and nafamostat mesylate anticoagulation during plasma exchange for children at high bleeding risk: a retrospective study

Table 4 Comparative analysis of anticoagulation strategies for pediatric PE

Feature	Heparin-PE	RCA-PE	NM-PE
Filter Efficacy	Weaker than RCA	Good	Comparable to RCA
Advantages	Easy availability	Does not increase the risk of bleeding	Does not increase the risk of bleeding
Risk of adverse events	High bleeding risk, Heparin-induced thrombocytopenia	Metabolic alkalosis (common), Hypocalcemia	Hyperkalemia (rare)
Operational challenges	Needs aPTT/ACT monitoring	Requires simultaneous monitoring of systemic and extracorporeal circuit ionized calcium levels, leading to a substantial increase in clinical workload.	Needs aPTT/ACT monitoring
Half-life	1–5 h (dose-dependent)	5 min	5–8 min
Exclusion criteria	High bleeding risk, Heparin-induced thrombocytopenia	Severe liver dysfunction PO₂<60 mmHg	Hypersensitivity history
Cost	The costs of heparin and coagulation function tests; Low cost	The costs of citrate along with intravascular and extracorporeal ionized calcium monitoring as well as coagulation function tests; The highest cost	The costs of nafamostat mesylate and coagulation function tests; Moderate cost
Availability	Universally available	Limited to specialized centers	Restricted (China, Japan, and Korea mainly)

PE: plasma exchange; RCA: regional citrate anticoagulation; NM: nafamostat mesylate; aPTT: activated partial thromboplastin time; ACT: activated clotting time

ISSN: 1824-7288