Department of Nephrology, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, Italy.
Curr Vasc Pharmacol. 2014 May;12(3):512-7. doi: 10.2174/157016111203140518172048.
Patients with nephrotic syndrome are at increased risk for thromboembolic events such as deep venous and arterial thrombosis, renal vein thrombosis and pulmonary embolism. This thrombophilic phenomenon has been attributed to a "hypercoagulable" state in which an imbalance between naturally occurring pro-coagulant/pro-thrombotic factors and anti-coagulant/antithrombotic factors promotes in situ thrombosis in deep veins or arteries. Management of thromboembolic events may be divided in prophylactic and therapeutic strategies. Hypoalbuminemia is the most significant independent predictor factor of thrombotic risk, especially for values <2 g/dL. However, the most important question in these patients is whether to anticoagulate prophylactically or not. The decision depends on type of glomerulonephritis, proteinuria severity, other predisposing factors and prior history of thrombosis. Reviewing the recent literature, we suggest the best therapeutic management of anticoagulation for patients with nephrotic syndrome, focusing on prophylactic strategies.
肾病综合征患者发生深静脉和动脉血栓形成、肾静脉血栓形成和肺栓塞等血栓栓塞事件的风险增加。这种血栓形成倾向可归因于一种“高凝状态”，其中天然存在的促凝/血栓形成因子与抗凝/抗血栓形成因子之间的失衡促进深静脉或动脉中的原位血栓形成。血栓栓塞事件的管理可分为预防和治疗策略。低白蛋白血症是血栓形成风险的最重要独立预测因素，尤其是白蛋白值 <2 g/dL 时。然而，这些患者最重要的问题是是否预防性抗凝。该决定取决于肾小球肾炎的类型、蛋白尿严重程度、其他诱发因素和既往血栓形成史。回顾最近的文献，我们建议对肾病综合征患者的抗凝治疗进行最佳治疗管理，重点关注预防策略。
