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Abstract: SA-PO710

Direct Oral Anticoagulants vs. Warfarin for Venous Thromboembolism Prophylaxis in Patients With Nephrotic Syndrome: A Retrospective Cohort Study

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Stanilova, Katerina, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Tijani, Aminat A., Ochsner Medical Center, New Orleans, Louisiana, United States
  • Coons, Eric M., Ochsner Medical Center, New Orleans, Louisiana, United States
  • Casey, Ashley, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Mizuki, Britta, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Dermady, Miranda, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Bamnolker, Adi, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Alqudsi, Muhannad, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Medical Center, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

Hypercoagulability with resultant venous thromboembolism (VTE) is a common feature of nephrotic syndrome (NS). Anticoagulation with warfarin is standard of care for patients with NS and serum albumin < 2.5 g/dL, whereas the evidence supporting the use of direct oral anticoagulants (DOACs) for VTE prophylaxis in NS is mostly limited to case reports. We examined the rates of bleeding and thromboembolic event rates in patients with NS receiving DOACs or warfarin for VTE prophylaxis.

Methods

A retrospective cohort study was conducted in adults with NS treated with a DOAC or warfarin for VTE prophylaxis for ≥ 7 days and with ≥ 2 encounters documented within the Ochsner Health System between January 2013 and July 2021. Patients were excluded if they had a prior VTE within 6 months or had known prior exposure to a study drug. The primary outcome was the composite rate of major and clinically relevant non-major bleeding. Secondary outcomes included time to bleeding events and the rate of new thromboembolic events.

Results

Of 171 patients screened, 44 patients were included in the study (25 in the DOAC cohort and 19 in the warfarin cohort); median age 55 (41-64) years, 50% women, 63% self-identified black. Median follow-up was 7.8 (4.6-18.7) months. Median urine protein-to-creatinine ratio, serum albumin and serum creatinine were 8.6 (5.0-11.8) g/g, 1.6 (1.2-2.1) g/dL and 1.3 (0.8-2.1) mg/dL, respectively. The most common etiology of NS was membranous nephropathy: 14 (56%) in the DOAC group [12 of them phospholipase A2 receptor (PLA2R)+] and 9 (47%) in the warfarin group [4 of them PLA2R+]. The primary outcome occurred in 2 patients treated with a DOAC and 5 patients treated with warfarin (8% vs 26%, p=0.21). The primary outcome was driven by major bleeding (4% vs 21%, p=0.15). There was no difference in time to major bleeding (250 vs 340 days, p=1.00). One new VTE event occurred in the DOAC cohort.

Conclusion

Bleeding and thromboembolic events were similar in patients with NS treated with a DOAC or warfarin for VTE prophylaxis. This study adds comparative data for VTE prophylaxis in patients with NS. Larger prospective studies are still warranted.