Abstract: Objective To compare the anticoagulation efficacy, safety, and economic benefits of Nafamostat Mesylate (NM) injection versus Regional Citrate Anticoagulation (RCA) in hemodialysis for uremic patients at high risk of bleeding.  Methods  A retrospective analysis was conducted on uremic patients at high risk of bleeding who underwent hemodialysis in the Department of Nephrology, First Affiliated Hospital of Army Medical University, between January 2016 and December 2023. Patients were divided into the NM group and the RCA group. The effectiveness and safety were compared between the two groups, and the incremental cost-effectiveness ratio (ICER) was calculated.  Results  A total of 91 patients were included, with 59 in the NM group and 32 in the RCA group. No statistically significant difference was found in anticoagulation efficacy between the NM and RCA groups (96.61% vs. 87.50%,  χ²=2.796, P=0.095). The NM group showed lower rates of premature termination due to clotting events (0% vs. 9.38%, χ²=5.720, P=0.017), Grade 3 clotting events (1.69% vs. 12.50%, χ²=4.665, P=0.031), and hypocalcemia (0% vs. 12.50%, χ²=7.714, P=0.005) compared to the RCA group. Compared to RCA, the ICER for NM was -1843.91 Chinese Yuan.  Conclusion  As an anticoagulant for hemodialysis in patients at high risk of bleeding, NM demonstrates favorable efficacy and safety, along with good cost-effectiveness. 

Key words: Nafamostat mesylate, Regional citrate anticoagulation, High-risk bleeding, Hemodialysis, Anticoagulation efficacy