A CASE OF HEPATIC RESECTION USING NAFAMOSTAT MESILATE (FUT) AS AN ANTICOAGULATIVE AND ANTIFIBRINOLYTIC AGENT FOR HEPATIC VENO-VENOUS BYPASS

Abstract

Nafamostat mesilate (FUT) is a protease inhibitor with inhibitory effects of coagulation, fibrinolysis, and platelet aggregation. We occasionally experienced intraoperative and postoperative hemostatic disturbances in total hepatic vascular exclusion (THVE) with veno-venous bypass in spite of using heparin bonded circuit. It has been considered that more significant changes in hemostasis occur during the anhepatic period with the use of venous bypass. Therefore we tried FUT as an anticoagulative and antifibrinolytic agent for venous bypass. We herein present a 58-year-old woman with giant hepatocellular carcinoma (HCC) occupying the right lobe. Preoperative imaging studies revealed massive HCC involving the inferior vena cava. The patient successfully underwent extended right hepatectomy using THVE technique with conventional venous bypass. Non heparin bonded circuit was used in this case. FUT was continuously infused during bypass. We did not find the tendency of oozing after reperfusion, intracurcuit clots formation, and any complications due to thrombus. Postoperatively, the patient had an uneventful recovery and was discharged 20 days after the operation. We believe that FUT is useful for reduction of blood loss as a new anticoagulant and antifibrinolytic agent for hepatic veno-venous bypass without heparin bonded circuit.