Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications
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 patt...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2023-10-01
|
| Series: | Glomerular Diseases |
| Online Access: | https://beta.karger.com/Article/FullText/534652 |
| _version_ | 1797447840724680704 |
|---|---|
| author | Thomas McDonnell John Hartemink Omar Ragy Kathrine Parker Meshaal Shukkur Jecko Thachil Durga Kanigicherla |
| author_facet | Thomas McDonnell John Hartemink Omar Ragy Kathrine Parker Meshaal Shukkur Jecko Thachil Durga Kanigicherla |
| author_sort | Thomas McDonnell |
| collection | DOAJ |
| description | 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: 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
54 patients with MN and 48 with podocytopathies were included. Baseline demographics and severity of NS was comparable. Those with MN were more likely to develop TEE 12(22%) vs 4(8%) (p=0.027) though this difference was predominantly seen at index diagnosis. Only 2 patients developed TEEs during active incident nephrotic syndrome. Rates of PAC were similar 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 iNS). Warfarin was the most common agent used in MN cohort 18/26 (69%) vs 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 nephrotic syndrome. |
| first_indexed | 2024-03-09T14:01:47Z |
| format | Article |
| id | doaj.art-42d12bce607a41069dff9b5e4aaad2c8 |
| institution | Directory Open Access Journal |
| issn | 2673-3633 |
| language | English |
| last_indexed | 2024-03-09T14:01:47Z |
| publishDate | 2023-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Glomerular Diseases |
| spelling | doaj.art-42d12bce607a41069dff9b5e4aaad2c82023-11-30T07:27:23ZengKarger PublishersGlomerular Diseases2673-36332023-10-011110.1159/000534652534652Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic ComplicationsThomas McDonnellJohn HarteminkOmar RagyKathrine ParkerMeshaal ShukkurJecko ThachilDurga KanigicherlaIntroduction 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: 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 54 patients with MN and 48 with podocytopathies were included. Baseline demographics and severity of NS was comparable. Those with MN were more likely to develop TEE 12(22%) vs 4(8%) (p=0.027) though this difference was predominantly seen at index diagnosis. Only 2 patients developed TEEs during active incident nephrotic syndrome. Rates of PAC were similar 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 iNS). Warfarin was the most common agent used in MN cohort 18/26 (69%) vs 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 nephrotic syndrome.https://beta.karger.com/Article/FullText/534652 |
| spellingShingle | Thomas McDonnell John Hartemink Omar Ragy Kathrine Parker Meshaal Shukkur Jecko Thachil Durga Kanigicherla Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications Glomerular Diseases |
| title | Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications |
| title_full | Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications |
| title_fullStr | Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications |
| title_full_unstemmed | Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications |
| title_short | Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications |
| title_sort | longitudinal analysis of prophylactic anticoagulation in primary nephrotic syndrome low incidence of thromboembolic complications |
| url | https://beta.karger.com/Article/FullText/534652 |
| work_keys_str_mv | AT thomasmcdonnell longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications AT johnhartemink longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications AT omarragy longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications AT kathrineparker longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications AT meshaalshukkur longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications AT jeckothachil longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications AT durgakanigicherla longitudinalanalysisofprophylacticanticoagulationinprimarynephroticsyndromelowincidenceofthromboemboliccomplications |