Abstract: SA-PO0858
Direct Oral Anticoagulants vs. Standard of Care in Nephrotic Syndrome
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Lorenzo Capps, Maria Jose, Rutgers The State University of New Jersey, New Brunswick, New Jersey, United States
- Vega Batista, Franklyn, Rutgers The State University of New Jersey, New Brunswick, New Jersey, United States
- Adelizzi, Angela M., Rutgers The State University of New Jersey, New Brunswick, New Jersey, United States
Background
Adults with nephrotic syndrome (NS) have an elevated risk of venous and arterial thromboembolism. Evidence comparing direct oral anticoagulants (DOACs) with standard-of-care (SOC) anticoagulation using warfarin/vitamin K antagonists (VKA) or heparin-based regimens for thromboprophylaxis remains limited.
Methods
We conducted a PRISMA-aligned systematic review of comparative studies in adults with NS, defined by nephrotic-range proteinuria and hypoalbuminemia. Searches included MEDLINE/PubMed, Embase, CENTRAL, Scopus, Web of Science, ClinicalTrials.gov, and reference lists. Two reviewers independently screened studies and extracted data. Eligible designs included randomized, quasi-randomized, and comparative observational cohorts evaluating DOACs versus VKA/heparin-based SOC. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was graded using GRADE. Outcomes of interest were thrombotic events and bleeding.
Results
Four retrospective cohort studies met inclusion: Cubilier 2025 (n=133; DOAC 51 vs VKA 82), Tijani 2022 (n=44; 25 DOAC vs 19 warfarin), El-Bardissy 2025 (n=57; 26 DOAC vs 31 warfarin), and Al Jurdi 2023 (n=66; 11 apixaban vs 7 warfarin), all evaluating prophylaxis. DOAC agents included rivaroxaban, dabigatran, and apixaban. Thrombotic events were infrequent. El-Bardissy 2025 reported 2 events (renal vein thrombosis/pulmonary embolism) in the DOAC group versus 0 with warfarin (p=0.2). Al Jurdi 2023 observed 0 events with apixaban versus 1 with warfarin (log-rank p=0.041). Cubilier 2025 found similar composite event rates (p=0.481), with few thrombotic events.
Bleeding outcomes were variably reported. Tijani 2022 showed major bleeding in 4% of DOAC versus 21% of warfarin patients (p=0.25), and composite bleeding rates of 8% versus 26.3% (p=0.21). El-Bardissy 2025 reported similar major bleeding (1 event per group; p=1.00) but significantly lower non-major bleeding with DOACs (3 vs 9; p=0.02). Cubilier 2025 reported 7 bleeding events within a composite outcome without arm-specific detail.
Conclusion
In limited retrospective NS cohorts, DOACs demonstrate comparable thromboprophylactic efficacy to VKA/SOC, signals toward reduced non-major bleeding in one study and numerically favorable but inconclusive bleeding trends elsewhere. Overall certainty is low due to study design and sparse reporting. Prospective randomized trials are needed to clarify the balance between thrombotic prevention vs bleeding risk in NS.