Introduction:
Nephrotic syndrome (NS) is associated with a heightened risk of thromboembolic events (TE), which significantly contribute to increased morbidity and mortality in affected patients. International guidelines advocate for prophylactic anticoagulation in patients with NS at high risk of TE. However, the optimal anticoagulation strategy in this population remains undefined. Warfarin, commonly prescribed for this purpose, necessitates frequent monitoring and carries a substantial risk of adverse effects. This study aimed to evaluate the effectiveness and safety of direct oral anticoagulants (DOACs) in preventing and treating TE in patients with NS.
Methods:
We conducted a single-centre, prospective observational study from January 2024 to July 2024, involving patients with NS who had serum albumin levels below 2.5 g/L. Patients were selected for DOAC therapy following an assessment using the GN-risk-score tool.Baseline characteristics, thromboembolic events, bleeding episodes, and other adverse effects related to DOAC therapy were recorded.
Results:
A total of 40 patients with NS were enrolled in the study, with a mean age of 35.2 ± 16.7 years, including 14 females. Among them, 38 patients received DOACs for thromboprophylaxis, and 2 patients were treated for TE. The cohort included patients with membranous nephropathy (n=6), minimal change disease (n=10), focal segmental glomerulosclerosis (n=10), and lupus nephritis (n=14). The mean proteinuria was 12.20 ± 3.38 g/24 h, serum albumin was 1.46 ± 0.37 g/dL, and serum creatinine was 0.83 ± 0.14 mg/dL. Over a minimum anticoagulation period of 1 month and a maximum of 3 months, no TE was observed, and only 2 patients experienced minor bleeding episodes.
Conclusions:
DOACs demonstrated safety and efficacy in the prevention and treatment of TE in adult NS patients, with only minimal bleeding complications reported. These findings suggest that DOACs could be a viable alternative to traditional anticoagulation strategies in this high-risk population.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.