Prophylactic anticoagulants to prevent venous thromboembolism in patients with nephrotic syndrome-A retrospective observational study.

Frida Welander,Emöke Dimény,Ulf Jansson,Anders Själander,Henrik Holmberg

doi:10.1371/journal.pone.0255009

Frida Welander, Emöke Dimény + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0255009

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Journal: PloS one	Publication Date: Jul 28, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Umeå University, Sundsvall Municipality

Abstract

Nephrotic syndrome (NS) is associated with increased risk of venous thromboembolism (VTE). Guidelines suggest prophylactic anticoagulants to patients with high risk of thrombosis and low risk of bleeding, but the evidence behind this is poor. This study aims to investigate the effectiveness and risks of prophylactic anticoagulants (PAC) and investigate risk factors for VTE and bleeding in NS. A retrospective medical records study including adults with NS, biopsy proven glomerular disease in the county of Västernorrland, Sweden. Outcomes were VTE, bleeding and death. Patients divided into PAC- and no PAC group were compared using Fisher's exact test. Patient time was divided into serum/plasma(S/P)-albumin intervals (<20g/L and ≥20g/L) and VTE- and bleeding rates were calculated. In 95 included NS patients (PAC = 40, no PAC = 55), 7 VTE (7.4%) and 17 bleedings (18%) were found. Outcomes didn't differ significantly between the PAC and no PAC group. Time with S/P-albumin <20g/L conferred higher rates/100 years of VTE (IRR 21.7 (95%CI 4.5-116.5)) and bleeding (IRR 5.0 (1.4-14.7)), compared to time with S/P-albumin>20g/L. Duration of severe hypoalbuminemia (S/P-albumin <20g/L) in NS is a risk factor for both VTE and bleeding. There is a need for randomized controlled studies regarding the benefit of PAC in NS as well as risk factors of thrombosis and bleeding in NS.

Highlights

Nephrotic syndrome (NS) is defined as urine protein loss > 3.5g/24 hours associated with hypoalbuminemia and oedema
The present study shows that duration of severe hypoalbuminemia, S/P-albumin
Several studies have shown a correlation between degree of hypoalbuminemia and risk of venous thromboembolism (VTE); Lionaki et al showed a threshold of S-albumin 28g/l below which the VTE risk increases and a nearly 6-fold increased risk of VTE at S-albumin 22g/L compared to >28g/L in patients with membranous nephropathy [15]

Summary

Introduction

Nephrotic syndrome (NS) is defined as urine protein loss > 3.5g/24 hours associated with hypoalbuminemia and oedema. It is well known that patients with NS have increased risk of thromboembolic complications, mainly venous [2]. The risk of thromboembolism is especially high in NS patients with membranous nephropathy, minimal change disease and membranoproliferative glomerulonephritis [3]. The proneness to VTE during NS can be explained mainly by increased production of prothrombotic factors and increased urine loss of antithrombotic factors. Nephrotic syndrome (NS) is associated with increased risk of venous thromboembolism (VTE). Guidelines suggest prophylactic anticoagulants to patients with high risk of thrombosis and low risk of bleeding, but the evidence behind this is poor.

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