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Abstract: SA-PO915

Anticoagulation Thromboprophylaxis Is More Effective than Antiplatelet Thromboprophylaxis for Individuals with High-Risk Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Al Jurdi, Ayman, Massachusetts General Hospital, Boston, Massachusetts, United States
  • El Mouhayyar, Christopher, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Yatim, Karim, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Efe, Orhan, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Muhsin, Saif A., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Riella, Leonardo V., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Zonozi, Reza, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Laliberte, Karen A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Niles, John, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Jeyabalan, Anushya, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Data on the use of apixaban and antiplatelet therapies for thromboprophylaxis in MN are limited.

Methods

We conducted a multicenter retrospective cohort study of all individuals with high-risk MN, defined as having a serum albumin nadir < 2.5 g/dL in the setting of nephrotic-range proteinuria. The primary outcome was the incidence of thrombotic events within 12 months, stratified by thromboprophylaxis strategy.

Results

66 individuals met the study’s inclusion criteria. Median serum creatinine was 1.2 mg/dL (IQR 0.9-1.5), median UPCR was 12.2 g/g (IQR 8.5-16.6), and mean nadir serum albumin level was 1.9 ± 0.4 g/dL. 23 (35%) received no thromboprophylaxis, 20 (30%) received antiplatelet [AP] prophylaxis, and 23 (35%) received anticoagulant [AC] prophylaxis. Thrombotic events occurred in 11 subjects (17%): 1 in the AC group, 4 in the AP group, and 6 in the no prophylaxis group. No thrombotic events occurred in individuals who received apixaban (n = 11), while one individual in the warfarin group (n = 7) developed a recurrent ischemic stroke. The incidence of thrombotic events was lower in the AC group compared to both AP and no prophylaxis groups (log-rank P = 0.041, Fig 1A). In individuals with anti-PLA2R antibody-associated MN, higher anti-PLA2R antibody levels were associated with a higher risk of thrombotic events (Fig 1B) at various levels of serum albumin (Fig 1C). Three subjects had significant bleeding events, 1 in the AP group and 2 in the AC group.

Conclusion

AC prophylaxis, including apixaban, is associated with a lower risk of thrombotic events compared to AP or no prophylaxis in individuals with high-risk MN.

Figure 1. Thrombotic risk in individuals with high-risk Membranous nephropathy (MN).