Prophylactic Anticoagulation in Nephrotic Syndrome

Glassock, Richard J.

doi:10.1681/asn.2006111300

Cited by 182 publications

(171 citation statements)

References 30 publications

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“…Despite the well-established risk of VTE in nephrotic syndrome, the most effective method of VTE prophylaxis is unclear (3,6). However, to prevent the significant morbidity and mortality associated with VTE, many nephrologists prescribe prophylactic anticoagulation in nephrotic syndrome.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas

Ziaj

Condon

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Venous thromboembolism (VTE) occurs in 7%-40% of nephrotic patients. The risk of VTE depends on the severity and underlying cause of nephrotic syndrome. This study investigated the use of low-dose prophylactic anticoagulation to prevent VTE in patients with nephrotic syndrome caused by primary glomerulonephritis.Design, setting, participants, & measurements Since 2006, all patients presenting with nephrotic syndrome to Imperial College Kidney and Transplant Centre have been considered for treatment with a novel anticoagulation prophylaxis regimen. All cases of nephrotic syndrome secondary to primary membranous nephropathy, minimal-change disease, and FSGS over a 5-year period were retrospectively reviewed. Patients with serum albumin,2.0 g/dl received prophylactic-dose low-molecular-weight heparin or low-dose warfarin; patients with albumin levels of 2.0-3.0 g/dl received aspirin, 75 mg once daily. All thrombotic events and bleeding complications were recorded.Results A total of 143 patients received the prophylactic anticoagulation regimen. Median follow-up was 154 weeks (range, 30-298 weeks). The cohort had features associated with a high risk of developing VTE; 40% of the cohort had an underlying diagnosis of membranous nephropathy, and the initial median serum albumin was 1.5 g/dl (range, 0.5-2.9 g/dl). No VTE occurred in patients established on prophylaxis for at least 1 week. VTE was diagnosed in 2 of 143 patients (1.39%) within the first week after presentation and starting prophylaxis. In both cases, it is unclear whether the thrombus had developed before or after the start of prophylaxis. One of 143 (0.69%) patients receiving prophylaxis was admitted urgently with gastrointestinal hemorrhage. Two of 143 patients (1.40%) had elective blood transfusions and procedures to manage occult gastrointestinal bleeding. No other bleeding events occurred in patients receiving prophylaxis.Conclusions This regimen of prophylactic antiplatelet or anticoagulant therapy appears effective in preventing VTE in nephrotic syndrome, with relatively few hemorrhagic complications.

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Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas

Ziaj

Condon

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Although thrombosis could potentially be prevented with prophylactic anticoagulation, this approach remains controversial because of the treatment-associated risk of bleeding complications. [10][11][12] Recent epidemiologic studies have revealed that both proteinuria and serum albumin may be associated with the likelihood of thrombosis, with higher proteinuria and lower serum albumin correlating with increased thrombotic risk, suggesting that disease severity may be directly correlated with the severity of coagulation system derangement. [13][14][15][16][17][18] Thus, determining the relationship between hypercoagulopathy and these markers of disease severity may lead to the identification of clinically meaningful urine protein and/or serum albumin levels beyond which prophylaxis with anticoagulants may be warranted.…”

mentioning

confidence: 99%

Disease Severity Correlates with Thrombotic Capacity in Experimental Nephrotic Syndrome

Kerlin

Waller

Sharma

et al. 2015

Journal of the American Society of Nephrology

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Thrombotic disease, a major life-threatening complication of nephrotic syndrome, has been associated with proteinuria and hypoalbuminemia severity. However, it is not fully understood how disease severity correlates with severity of the acquired hypercoagulopathy of nephrotic syndrome. Without this knowledge, the utility of proteinuria and/or hypoalbuminemia as biomarkers of thrombotic risk remains limited. Here, we show that two well established ex vivo hypercoagulopathy assays, thrombin generation and rotational thromboelastometry, are highly correlated with proteinuria and hypoalbuminemia in the puromycin aminonucleoside and adriamycin rat models of nephrotic syndrome. Notably, in the puromycin aminonucleoside model, hyperfibrinogenemia and antithrombin deficiency were also correlated with proteinuria severity, consistent with reports in human nephrotic syndrome. Importantly, although coagulation was not spontaneously activated in vivo with increasing proteinuria, vascular injury induced a more robust thrombotic response in nephrotic animals. In conclusion, hypercoagulopathy is highly correlated with nephrotic disease severity, but overt thrombosis may require an initiating insult, such as vascular injury. Our results suggest that proteinuria and/or hypoalbuminemia could be developed as clinically meaningful surrogate biomarkers of hypercoagulopathy to identify patients with nephrotic syndrome at highest risk for thrombotic disease and potentially target them for anticoagulant pharmacoprophylaxis.

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“…Thromboembolic events most commonly involve the renal vein, deep vein of the lower limbs in patients with the greatest risk seen in membranous glomerulopathy, menbranoproliferative glomerulonephritis, and minimal change disease among subtypes of nephrotic syndrome [2,3]. Portal vein thrombosis is rare.…”

Section: Casementioning

confidence: 99%