Abstract：Objective To investigate the anticoagulant effect and safety of nathomorestat mesylate and sodium citrate in patients with high-risk bleeding after continuous blood purification.Methods High-risk bleeding patients who received continuous renal replacement therapy (CRRT) in the nephrology department of the Third People's Hospital of Yunnan Province from January 2021 to June 2022 were selected as the study objects.Patients were divided into naproxat mesylate group and sodium citrate group according to random number table method, with 50 cases in each group.Naphthalmostat mesylate group was given anticoagulation, sodium citrate group was given anticoagulation.Blood routine, biochemistry, coagulation function, dialyzer life span, clotting causes, blood transfusion volume, 60 days survival rate after CRRT initiation and anticoagulant related adverse reactions were compared between the two groups before and after treatment.Results Before treatment, there were no significant differences in blood routine, liver function and Scr between 2 groups (all P>0.05). After treatment, the Scr and BUN levels in 2 groups were significantly decreased compared with those before treatment, and the decrease was greater in naphthalmorestat mesylate group, with statistical significance (all P<0.05). The dialyzer life span, the number of filters used at 24 h, the proportion of filter life （more than 12 h） and the coagulation events of dialyzer were better in nathomostat mesylate group than in sodium citrate group, while the proportion of patients with continuous TMP （more than 200 mmHg） and the number of suspended red blood cells and platelets were lower than those in sodium citrate group, with statistical significance (all P<0.05).There was no significant difference in survival time at 60 days after CRRT initiation between the two groups (χ2=0.017, P=0.898).The incidence of aggravated bleeding in naproxat mesylate group and sodium citrate group was 12% (6/50) and 10% (5/50), respectively, with no significant difference (χ2=0.102, P=0.749).Anaphylaxis occurred in 2 patients (4%) in naproxat mesylate group, which was manifested as facial flushing and skin pruritus, which was relieved after antiallergic treatment with dexamethasone sodium phosphate injection, while no anaphylaxis was observed in sodium citrate group.Conclusions Naproxat mesylate is a safe and effective anticoagulant for CRRT in patients with bleeding risk, contraindications with heparin or low molecular weight heparin, and impaired metabolism of sodium citrate.
