ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO664

Direct Oral Anticoagulants for Prophylaxis Against Thromboembolism in Patients With Nephrotic Syndrome

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Osman, Omar, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Muaddi, Luba, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Arora, Swati, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
Background

Nephrotic Syndrome (NS) is associated with an increased risk of arterial and venous thromboembolic (VTE) complications when serum albumin is below 2.5 g/dL. Few case reports discussed the use of direct oral anticoagulants (DOACs) as treatment and prophylaxis for thromboembolism in patients with NS. The importance of this case series is to add to the existing literature on the experience of using DOACs in NS.

Methods

Charts of 9 patients with NS on DOACs were reviewed. Seven patients had biopsy proven membranous nephropathy, one patient had Class IV Lupus Nephritis and one had primary FSGS. Seven patients were using DOACs purely for VTE prophylaxis, one patient was already on DOAC for atrial fibrillation and one patient was on DOAC for treatment of an acute VTE. Demographic data along with baseline proteinuria, serum albumin and bleeding events were obtained for all patients.

Results

Of the 9 patients identified, 1 patient was given rivaroxaban for treatment of IVC thrombus which was extending into the renal veins. The remaining patients used apixaban as a form of prophylaxis for VTE. Follow up for patients on apixaban varied 3 to 24 months during which none of the patients developed VTE. DOACs were discontinued once serum albumin became greater than 2.5g/dL. Only one patient remained on a DOAC for an alternative indication.

Conclusion

The importance of our results highlight the use of DOACs for treatment and prophylaxis for VTE. Prior literature identifies successful use of DOACs for prophylaxis in 2 patients illustrated by Sexton et. al. Concern for use of DOACs in patients with nephrotic syndrome is based on data that they are highly protein bound and so this questions the efficacy of DOACs in NS. However, given that there are real world examples of successful use of DOACs for treatment and prophylaxis of VTE in nephrotic syndrome patients, we recommend further studies to evaluate the efficacy of DOACs in prevention of VTE compared to the current standard of care.