School of Pharmacy, University of Maryland, Baltimore, MD, USA.
Ann Pharmacother. 2013 May;47(5):725-34. doi: 10.1345/aph.1R530. Epub 2013 Apr 23.
To review published literature regarding use of strategies to prevent thrombotic events in patients with nephrotic syndrome (NS).
The MEDLINE/PubMed, EMBASE, and Cochrane databases were queried from 1980 to December 2012 for articles in English using the search terms nephrotic syndrome, thrombosis, thromboembolism, anticoagulation, warfarin, heparin, low-molecular-weight heparin, enoxaparin, dalteparin, tinzaparin, statin, atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin, aspirin, direct thrombin inhibitor, rivaroxaban, argatroban, lepirudin, bivalirudin, dabigatran, factor Xa inhibitor, fondaparinux, rivaroxaban, clopidogrel, ticlopidine, and prasugrel.
All relevant original studies, meta-analyses, systematic reviews, guidelines, and review articles were assessed for inclusion. References from pertinent articles were examined for additional content not found during the initial search.
NS leads to multiple complications, including hypercoagulability. A small prospective cohort study used enoxaparin for primary prophylaxis and demonstrated successful prevention of thrombotic events with minimal adverse events. Additional information has come in the form of decision analyses, which show potential decreased morbidity and mortality when primary prophylaxis for thrombotic events is used; however, all data have numerous limitations. Other strategies for thrombus prevention, including statins and antiplatelet agents, also have been investigated.
When patients with NS are admitted to the hospital, develop an acute medical illness, or acquire an additional thrombotic events risk factor such as surgery, active malignancy, or pregnancy, consideration for primary pharmacologic prophylaxis with appropriately dosed low-molecular-weight heparin or other indicated anticoagulant should include the potential for increased thrombotic events risk in this patient population. Consideration may also be given to the use of primary pharmacologic prophylaxis with low-molecular-weight heparin or oral vitamin K antagonist in patients with membranous nephropathy once the albumin level drops below 2.0-2.5 g/dL. Short-term use of pharmacologic prophylaxis during the first 6 months following diagnosis warrants further investigation.
回顾已发表的文献，了解肾病综合征（NS）患者预防血栓事件的策略。
从 1980 年至 2012 年 12 月，通过使用搜索词肾病综合征、血栓形成、血栓栓塞、抗凝、华法林、肝素、低分子肝素、依诺肝素、达肝素、那屈肝素、辛伐他汀、阿托伐他汀、氟伐他汀、洛伐他汀、匹伐他汀、普伐他汀、罗苏伐他汀、辛伐他汀、阿司匹林、直接凝血酶抑制剂、利伐沙班、阿加曲班、来匹卢定、比伐卢定、达比加群、因子 Xa 抑制剂、磺达肝癸钠、利伐沙班、氯吡格雷、噻氯匹定、普拉格雷等，在 MEDLINE/PubMed、EMBASE 和 Cochrane 数据库中检索英文文章。
所有相关的原始研究、荟萃分析、系统评价、指南和综述文章都被评估为纳入对象。从相关文章的参考文献中，查阅了在最初搜索中未找到的其他内容。
NS 导致多种并发症，包括高凝状态。一项小的前瞻性队列研究使用依诺肝素进行一级预防，成功预防了血栓事件，且不良事件很少。此外，还进行了决策分析，表明在使用血栓事件一级预防时，潜在的发病率和死亡率降低；然而，所有数据都有许多局限性。其他血栓预防策略，包括他汀类药物和抗血小板药物，也已经被研究过。
当 NS 患者住院、发生急性内科疾病或获得其他血栓形成危险因素（如手术、活动性恶性肿瘤或妊娠）时，应考虑使用适当剂量的低分子肝素或其他有指征的抗凝剂进行一级药物预防，因为这类患者人群的血栓形成风险可能增加。对于膜性肾病患者，一旦白蛋白水平降至 2.0-2.5 g/dL 以下，也可以考虑使用低分子肝素或口服维生素 K 拮抗剂进行一级药物预防。在诊断后前 6 个月内短期使用药物预防需要进一步研究。
