Imperial College Kidney and Transplant Centre, London, United Kingdom.
Clin J Am Soc Nephrol. 2014 Mar;9(3):478-83. doi: 10.2215/CJN.07190713. Epub 2013 Dec 12.
Venous thromboembolism (VTE) occurs in 7%-40% of nephrotic patients. The risk of VTE depends on the severity and underlying cause of nephrotic syndrome. This study investigated the use of low-dose prophylactic anticoagulation to prevent VTE in patients with nephrotic syndrome caused by primary glomerulonephritis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Since 2006, all patients presenting with nephrotic syndrome to Imperial College Kidney and Transplant Centre have been considered for treatment with a novel anticoagulation prophylaxis regimen. All cases of nephrotic syndrome secondary to primary membranous nephropathy, minimal-change disease, and FSGS over a 5-year period were retrospectively reviewed. Patients with serum albumin<2.0 g/dl received prophylactic-dose low-molecular-weight heparin or low-dose warfarin; patients with albumin levels of 2.0-3.0 g/dl received aspirin, 75 mg once daily. All thrombotic events and bleeding complications were recorded.
A total of 143 patients received the prophylactic anticoagulation regimen. Median follow-up was 154 weeks (range, 30-298 weeks). The cohort had features associated with a high risk of developing VTE; 40% of the cohort had an underlying diagnosis of membranous nephropathy, and the initial median serum albumin was 1.5 g/dl (range, 0.5-2.9 g/dl). No VTE occurred in patients established on prophylaxis for at least 1 week. VTE was diagnosed in 2 of 143 patients (1.39%) within the first week after presentation and starting prophylaxis. In both cases, it is unclear whether the thrombus had developed before or after the start of prophylaxis. One of 143 (0.69%) patients receiving prophylaxis was admitted urgently with gastrointestinal hemorrhage. Two of 143 patients (1.40%) had elective blood transfusions and procedures to manage occult gastrointestinal bleeding. No other bleeding events occurred in patients receiving prophylaxis.
This regimen of prophylactic antiplatelet or anticoagulant therapy appears effective in preventing VTE in nephrotic syndrome, with relatively few hemorrhagic complications.
静脉血栓栓塞症（VTE）在肾病患者中的发生率为 7%-40%。VTE 的风险取决于肾病综合征的严重程度和潜在病因。本研究旨在探讨低剂量预防性抗凝治疗在原发性肾小球肾炎所致肾病综合征患者中预防 VTE 的效果。
设计、地点、参与者和测量方法：自 2006 年以来，帝国理工学院肾脏病和移植中心所有出现肾病综合征的患者均考虑采用一种新的抗凝预防方案进行治疗。回顾性分析了 5 年内继发于原发性膜性肾病、微小病变和 FSGS 的肾病综合征患者。血清白蛋白<2.0 g/dl 的患者接受预防性低分子肝素或低剂量华法林治疗；白蛋白水平为 2.0-3.0 g/dl 的患者接受阿司匹林，每日 75mg。记录所有血栓形成事件和出血并发症。
共有 143 例患者接受了预防性抗凝治疗方案。中位随访时间为 154 周（范围，30-298 周）。该队列具有发生 VTE 的高风险特征；40%的患者存在膜性肾病的基础诊断，初始中位血清白蛋白为 1.5 g/dl（范围，0.5-2.9 g/dl）。至少接受 1 周预防性治疗的患者均未发生 VTE。在出现症状和开始预防治疗的第 1 周内，2 例（1.39%）患者被诊断为 VTE。在这两种情况下，均不清楚血栓是在开始预防治疗之前还是之后形成的。143 例患者中有 1 例（0.69%）接受预防治疗的患者因胃肠道出血而紧急住院。143 例患者中有 2 例（1.40%）接受了择期输血和治疗隐匿性胃肠道出血的操作。接受预防治疗的患者未发生其他出血事件。
这种预防性抗血小板或抗凝治疗方案似乎可有效预防肾病综合征中的 VTE，且出血并发症相对较少。
