Direct-Acting Oral Anticoagulants as Prophylaxis Against Thromboembolism in the Nephrotic Syndrome

Sexton, Donal J.; Freitas, D. G. de; Little, Mark A.; McHugh, Tomas; Magee, Colm; Conlon, Peter J.; O’Seaghdha, Conall M.

doi:10.1016/j.ekir.2018.02.010

Cited by 36 publications

(31 citation statements)

References 54 publications

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“…Apixaban use was recently described for 2 patients with NS. 56 One had minimal change disease and was treated with prophylactic apixaban until remission. The second had MN with a remote history of VTE and received apixaban prophylaxis for 3 months until resolution of NS.…”

Section: Anticoagulation Scenarios In Kidney Diseasementioning

confidence: 99%

Role of direct oral anticoagulants in patients with kidney disease

Derebail

Rheault

Kerlin

2020

Kidney International

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The anticoagulation field is experiencing a renaissance that began with regulatory approval of the direct thrombin inhibitor dabigatran, a direct oral anticoagulant (DOAC), in 2010. The DOAC medication class has rapidly evolved to include the additional approval of 4 direct factor Xa inhibitors. Commensurately, DOAC use has increased and collectively account for the majority of new anticoagulant prescriptions. Despite exclusion of patients with moderateto-severe kidney disease from most pivotal DOAC trials, DOACs are increasingly used in this setting. An advantage of DOACs is similar or improved antithrombotic efficacy with less bleeding risk when compared with traditional agents. Several post hoc analyses, retrospective studies, claims data studies, and meta-analyses suggest that these benefits extend to patients with kidney disease. However, the lack of randomized controlled trial data in specific kidney disease settings, with their unique pathophysiology, should be a call to action for the kidney community to systematically study these agents, especially because early data suggest that DOACs may pose less risk of anticoagulant-related nephropathy than do vitamin K antagonists. Most DOACs are renally cleared and are significantly protein bound in circulation; thus, the pharmacokinetics of these drugs are influenced by reduced renal function and proteinuria. DOACs are susceptible to altered metabolism by P-glycoprotein inhibitors and inducers, including drugs commonly used for the management of kidney disease comorbidities. We summarize the currently available literature on DOAC use in kidney disease and illustrate knowledge gaps that represent important opportunities for prospective investigation.

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Section: Anticoagulation Scenarios In Kidney Diseasementioning

confidence: 99%

Role of direct oral anticoagulants in patients with kidney disease

Derebail

Rheault

Kerlin

2020

Kidney International

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“…Notably, apixaban and rivaroxaban are highly bound to plasma proteins (87, 90% ~ 95%) in humans, and serum albumin is the main binding component. If these drugs are considered for patients with hypoalbuminemia, the protein binding rate is an important consideration in primary MN [45, 46]. At present, although no pharmacokinetic study was available and no clinical trial had been performed in primary MN, some case reports reported the successful use of DOACs for the treatment of clinically evident thrombosis or thromboprophylaxis in primary MN [46].…”

Section: Results: Prevention Of Thrombogenesis and The Anticoagulant mentioning

confidence: 99%

Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy

Zou

2019

BMC Nephrol

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BackgroundIt has been recognized that primary membranous nephropathy (MN) is related to an increased risk for thromboembolic complications. However, the current evidence supporting prophylactic and therapeutic anticoagulation is too weak to better meet the clinical needs of this patient population. The present review provides some suggestions to guide the decision on anticoagulant management in primary MN patients with a high risk of thrombosis or with thromboembolic complication.Materials and methodsWe extracted relevant studies by searching the published literature using the Cochrane Library, Medline, PubMed and Web of Science from March 1968 to March 2018. Eligible publications included guidelines, reviews, case reports, and clinical trial studies that concerned the rational management of anticoagulation therapy in the primary MN population. The evidence was thematically synthesized to contextualize implementation issues.ResultsIt was helpful for clinicians to make a decision for personalized prophylactic aspirin or warfarin in primary MN patients when serum albumin was < 3.2 g/dl to prevent arterial and venous thromboembolic events (VTEs). The treatment regimen for thromboembolic complications (VTEs, acute coronary syndrome and ischemic stroke) in primary MN was almost similar to that for the general population with thromboembolic events. It is noteworthy that patients should continue the previous primary MN treatment protocol during the entire treatment period until they achieve remission, the protocol is complete and the underlying diseases resolve.ConclusionThe utility of prophylactic aspirin or warfarin may have clinical benefits for the primary prevention of thromboembolic events in primary MN with hypoalbuminemia. It is necessary to perform large randomized controlled trials and to formulate relevant guidelines to support the present review.

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“…The use of direct oral anticoagulants in NS or APS is controversial, and it is not generally recommended as previous trials were associated with more vascular events compared to that of warfarin, and with limited evidence, further studies are warranted [ 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke in a Young Patient with Nephrotic Syndrome and Antiphospholipid Syndrome

Neoh

Tang

Looi

et al. 2020

Case Reports in Nephrology

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We report a case of a 21-year-old man with underlying nephrotic syndrome (NS) secondary to minimal change disease, who developed an ischemic stroke with left hemiparesis. He received intravenous thrombolysis followed by a mechanical thrombectomy. After mechanical thrombectomy, he developed acute kidney injury which subsequently required haemodialysis. Further workup revealed that he had concomitant antiphospholipid syndrome (APS) and NS. He was started on vitamin K antagonist anticoagulant. This case report illustrates the importance of workup in identifying causes of ischemic stroke in a young patient.

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Direct-Acting Oral Anticoagulants as Prophylaxis Against Thromboembolism in the Nephrotic Syndrome

Cited by 36 publications

References 54 publications

Role of direct oral anticoagulants in patients with kidney disease

Role of direct oral anticoagulants in patients with kidney disease

Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy

Ischemic Stroke in a Young Patient with Nephrotic Syndrome and Antiphospholipid Syndrome

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