a Blood Purification Center , Beijing ChaoYang Hospital, Capital Medical University , Beijing , China.
b Department of Nephrology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.
Ren Fail. 2019 Nov;41(1):623-628. doi: 10.1080/0886022X.2019.1635030.
The aim of this study is to investigate the role of prophylactic anticoagulation regimens based on low molecular weight heparin (LMWH) or aspirin in thromboembolic events in patients with primary membranous nephropathy (PMN). A total of 717 patients with PMN were consecutively enrolled in this retrospective study. The propensity score matching method was utilized to adjust for the selection bias inherent in an analysis of outcomes, which was stratified by the anticoagulation prophylaxis regimen. According to the anticoagulation prophylaxis regimen, patients were assigned into three groups: only LMWH therapy (L + A-, = 53), only aspirin therapy (L - A+, = 97), and no therapy of LMWH or aspirin (L - A-, = 567). After performing 1:1 match, 37 patients were selected in the L + A - group and the L - A- group, respectively, and 94 patients were selected in the L - A+ group and the L - A- group, respectively. It showed that the prophylactic use of LMWH had no protective effects on arterial thromboembolic events (ATEs) (10.8% vs. 21.6%, = .21) or venous thromboembolic events (VTEs) (8.1% vs. 10.8%, = .69). The incidence of VTEs in the L - A+ group was lower than the L - A- group (2.1% vs. 10.6%, = .02), while there were no significant differences in the incidences of ATEs between the L - A+ group and the L - A- group (5.3% vs. 7.4%, = .55). The prophylactic use of LMWH showed no benefits on the incidence of ATEs or VTEs in patients with PMN. Aspirin effectively decreased the incidence of VTEs, without effects on the occurrence of ATEs.
本研究旨在探讨基于低分子肝素（LMWH）或阿司匹林的预防性抗凝方案在原发性膜性肾病（PMN）患者血栓栓塞事件中的作用。这项回顾性研究共纳入了 717 名 PMN 患者。采用倾向性评分匹配方法调整分析结果中的选择偏差，按抗凝预防方案进行分层。根据抗凝预防方案，患者分为三组：仅 LMWH 治疗（L+A-，n=53）、仅阿司匹林治疗（L-A+，n=97）和未接受 LMWH 或阿司匹林治疗（L-A-，n=567）。进行 1:1 匹配后，分别在 L+A-组和 L-A-组中选择 37 例患者，在 L-A+组和 L-A-组中分别选择 94 例患者。结果显示，预防性使用 LMWH 对动脉血栓栓塞事件（ATEs）（10.8% vs. 21.6%， = .21）或静脉血栓栓塞事件（VTEs）（8.1% vs. 10.8%， = .69）均无保护作用。L-A+组 VTE 发生率低于 L-A-组（2.1% vs. 10.6%， = .02），而 L-A+组与 L-A-组 ATE 发生率无显著差异（5.3% vs. 7.4%， = .55）。预防性使用 LMWH 对PMN 患者 ATEs 或 VTEs 的发生率无获益。阿司匹林可有效降低 VTE 的发生率，对 ATE 的发生无影响。
