Abstract:

Objective To retrieve，evaluate，and summarize the best evidence on the application and management of nafamostat mesilate（NM） anticoagulation in continuous renal replacement therapy（CRRT），providing an evidence-based foundation for clinical practice. Methods Systematic searches were conducted in domestic and international evidence-based resources and databases，including BMJ Best Practice，UpToDate，Cochrane Library，JBI EBP Database，PubMed，Embase，CNKI，Wanfang Data，and VIP. The search included guidelines，evidence summaries，systematic reviews，expert consensuses，and randomized controlled trials（RCTs） on the use of NM for anticoagulation in CRRT. The search timeframe was from database inception to July 30，2025. Two researchers independently performed literature quality appraisal and evidence extraction. Results A total of 21 publications were included，comprising four guidelines，three expert consensuses，five systematic reviews，five randomized controlled trials，and four observational studies. Twenty-seven best evidence statements were ultimately summarized across six domains，including indications for anticoagulation，contraindications，medication regimens，key monitoring points，complication management，and nursing practice. Conclusion Nafamostat mesilate，as a broad-spectrum serine protease inhibitor，offers distinct advantages for CRRT anticoagulation in patients at high risk of bleeding. Healthcare professionals are advised to develop a standardized administration protocol，implement meticulous monitoring，and adopt a multidisciplinary collaborative management model，tailored to the patient’s specific condition. This approach aims to maximize the therapeutic benefits of nafamostat，minimize complications，ensure the smooth implementation of CRRT，and improve patient outcomes.

Key words: Nafamostat Mesilate, Continuous Renal Replacement Therapy, Anticoagulation, Evidence-Based Practice, Evidence Summary