Achieving an optimal balance between thrombosis prevention and bleeding risk during temporary mechanical circulatory support remains a significant clinical challenge. Effective anticoagulation management that ensures device functionality while minimizing major bleeding events should have the potential to improve short-term outcomes. Here, we report the successful use of nafamostat mesilate (NM) as an anticoagulant during Impella support in two male patients with advanced heart failure and cardiogenic shock. NM therapy resulted in improved thrombocytopenia without the occurrence of major bleeding or thrombotic events. However, NM-related hyponatremia was observed, highlighting the need for careful monitoring during its administration and further cumulative evidence to validate optimal NM therapy during temporary mechanical circulatory supports.
