De Pascali Federica, Brunini Francesca, Rombolà Giuseppe, Squizzato Alessandro
Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese and Como, Italy.
Nephrology Unit, 'Ospedale di Circolo', ASST Sette Laghi, Varese, Italy.
Intern Med J. 2024 Feb;54(2):214-223. doi: 10.1111/imj.16227. Epub 2023 Sep 15.
Nephrotic syndrome (NS) is associated with an increased incidence of venous thromboembolism (VTE), approximately 10%. We performed a systematic review to evaluate the efficacy and safety of prophylactic anticoagulation in patients with NS.
Studies evaluating prophylactic anticoagulation in NS were identified by an electronic search of MEDLINE and EMBASE databases until December 2021. Weighted mean proportion and 95% confidence intervals (CIs) of thromboembolic and haemorrhagic events were calculated using a fixed-effects and a random-effects model. The differences in the outcomes among groups were estimated as pooled odds ratio (OR) and corresponding 95% CI. Statistical heterogeneity was evaluated using the I statistic.
Five cohort studies, for a total of 414 adult patients, were included. Only two studies had a control group. The weighted mean incidence of pulmonary embolism (PE) and deep vein thrombosis in patients who received VTE prophylaxis was 1.8% (95% CI: 0.6-3.5%; I : 4.4%) and 0.9% (95% CI: 0.2-2.2%; I : 43.4%) respectively. The weighted mean incidence of major bleeding in patients who received VTE prophylaxis was 2.3% (95% CI: 1-4.2%; I : 25.4%). Patients with NS that received VTE prophylaxis had a non-significant reduced risk of PE (OR: 0.63 (95% CI: 0.03-14.8; I : 64.4%)) and an increased risk of major bleeding (OR: 2.08 (95% CI: 0.41-10.45; I : 0%)) compared to patients with NS that did not receive VTE prophylaxis.
Our findings suggest that prophylactic anticoagulation in adult patients with primary NS may reduce the risk of VTE, even if it may be associated with a not negligible bleeding risk.
肾病综合征（NS）与静脉血栓栓塞症（VTE）的发病率增加相关，约为10%。我们进行了一项系统评价，以评估NS患者预防性抗凝的疗效和安全性。
通过电子检索MEDLINE和EMBASE数据库，检索截至2021年12月评估NS患者预防性抗凝的研究。使用固定效应模型和随机效应模型计算血栓栓塞和出血事件的加权平均比例及95%置信区间（CI）。组间结局差异以合并比值比（OR）及相应的95%CI进行估计。使用I²统计量评估统计异质性。
纳入了5项队列研究，共414例成年患者。仅有两项研究设有对照组。接受VTE预防的患者中，肺栓塞（PE）和深静脉血栓形成的加权平均发生率分别为1.8%（95%CI：0.6 - 3.5%；I²：4.4%）和0.9%（95%CI：0.2 - 2.2%；I²：43.4%）。接受VTE预防的患者中，大出血的加权平均发生率为2.3%（95%CI：1 - 4.2%；I²：25.4%）。与未接受VTE预防的NS患者相比，接受VTE预防的NS患者发生PE的风险降低但无统计学意义（OR：0.63（95%CI：0.03 - 14.8；I²：64.4%）），大出血风险增加（OR：2.08（95%CI：0.41 - 10.45；I²：0%））。
我们的研究结果表明，原发性NS成年患者预防性抗凝可能降低VTE风险，即便可能伴有不可忽视的出血风险。
