A Systematic Review of Prophylactic Anticoagulation in Nephrotic Syndrome

Raymond Lin; Georgina McDonald; Todd Jolly; Aidan Batten; Bobby Chacko

doi:10.1016/j.ekir.2019.12.001

A Systematic Review of Prophylactic Anticoagulation in Nephrotic Syndrome

Kidney Int Rep. 2019 Dec 12;5(4):435-447. doi: 10.1016/j.ekir.2019.12.001. eCollection 2020 Apr.

Authors

Raymond Lin¹, Georgina McDonald¹, Todd Jolly², Aidan Batten², Bobby Chacko^{1

2}

Affiliations

¹ Nephrology and Transplantation Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.
² School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.

Abstract

Introduction: Nephrotic syndrome is associated with an increased risk of venous and arterial thromboembolism, which can be as high as 40% depending on the severity and underlying cause of nephrotic syndrome. The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend prophylactic anticoagulation only in idiopathic membranous nephropathy but acknowledge that existing data are limited and of low quality. There is a need for better identification of vulnerable patients in order to balance the risks of anticoagulation.

Methods: We undertook a systematic search of the topic in MEDLINE, EMBASE and COCHRANE databases, for relevant articles between 1990 and 2019.

Results: A total of 2381 articles were screened, with 51 full-text articles reviewed. In all, 28 articles were included in the final review.

Conclusion: We discuss the key questions of whom to anticoagulate, when to anticoagulate, and how to prophylactically anticoagulate adults with nephrotic syndrome. Using available evidence, we expand upon current KDIGO guidelines and construct a clinical algorithm to aid decision making for prophylactic anticoagulation in nephrotic syndrome.

Keywords: anticoagulation; arterial thromboembolism; nephrotic syndrome; prophylaxis; venous thromboembolism.