Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications

Thomas McDonnell; John Hartemink; Omar Ragy; Katherine Parker; Meshaal Shukkur; Jecko Thachil; Durga Kanigicherla

doi:10.1159/000534652

Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications

Glomerular Dis. 2023 Oct 30;3(1):266-274. doi: 10.1159/000534652. eCollection 2023 Jan-Dec.

Authors

Thomas McDonnell¹, John Hartemink¹, Omar Ragy¹, Katherine Parker², Meshaal Shukkur¹, Jecko Thachil², Durga Kanigicherla^{1

3}

Affiliations

¹ Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
² Department of Hematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
³ Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.

Abstract

Introduction: Thromboembolic events (TEEs) are a serious and potentially fatal complication of nephrotic syndrome (NS). Despite this, there is a lack of evidence examining the benefits of prophylactic anticoagulation (PAC) in NS. It was our objective to review the risk factors, rates of TEEs, and patterns of PAC in patients with primary NS, with the aim to provide a pragmatic approach to PAC in primary NS.

Methods: This is a retrospective longitudinal cohort study of adult patients with primary NS. Included were as follows: biopsy-proven minimal change disease and focal segmental glomerulosclerosis (described as a combined podocytopathy cohort) plus membranous nephropathy (MN) over an 8-year period from a single centre. Anticoagulation practice, TEEs, and longer term outcomes were recorded.

Results: Fifty-four patients with MN and 48 patients with podocytopathies were included. Baseline demographics and severity of NS were comparable. Those with MN were more likely to develop TEE 12 (22%) versus 4 (8%) (p = 0.027) though this difference was predominantly seen at index diagnosis. Only 2 patients developed TEEs during active incident NS. Rates of PAC were similar when comparing MN (53%) and podocytopathies (58%). Those with a serum albumin <20 g/L and HAS-BLED score <3 were most likely to receive PAC (22/30, 73% in MN vs. 21/30, 70% in podocytopathy). Warfarin was the most common agent used in MN cohort 18/26 (69%) versus prophylactic dose low-molecular-weight heparin in the podocytopathy cohort 12/28 (43%).

Discussion/conclusion: PAC practices applied in this cohort of patients were pragmatic and effective, with low TEE rates during active NS.

Keywords: Nephrotic syndrome; Prophylactic anticoagulation; Thromboembolism.

Grants and funding

No funding was received for the project.