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A Systematic Review of Prophylactic Anticoagulation in Nephrotic Syndrome
Raymond Lin1, Georgina McDonald1, Todd Jolly2
1Nephrology and Transplantation Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.
Insights
Nephrotic syndrome increases thromboembolism risk. This review expands guidelines to identify and manage anticoagulation in high-risk patients, aiding clinical decisions.
Area of Science:
- Nephrology
- Hematology
- Clinical Medicine
Background:
- Nephrotic syndrome significantly elevates venous and arterial thromboembolism risk, potentially affecting up to 40% of patients.
- Current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines offer limited recommendations for prophylactic anticoagulation due to insufficient evidence.
- Identifying patients at high risk for thromboembolism is crucial for balancing anticoagulation benefits against bleeding risks.
Purpose of the Study:
- To systematically review the evidence on prophylactic anticoagulation in adult nephrotic syndrome patients.
- To address critical questions regarding patient selection, timing, and methods for anticoagulation.
- To develop a clinical algorithm to guide prophylactic anticoagulation decisions.
Main Methods:
- A systematic literature search was conducted across MEDLINE, EMBASE, and COCHRANE databases.
- The search covered relevant articles published between 1990 and 2019.
- A total of 2381 articles were screened, with 28 ultimately included in the final review.
Main Results:
- The review analyzed data from 28 selected articles.
- Key aspects of anticoagulation, including patient selection, timing, and modality, were examined.
- The findings provide a basis for refining current clinical practice guidelines.
Conclusions:
- The study provides an evidence-based discussion on prophylactic anticoagulation in nephrotic syndrome.
- A novel clinical algorithm is proposed to assist clinicians in decision-making.
- This work aims to improve the management of thromboembolism risk in nephrotic syndrome patients.
Introduction:
Nephrotic syndrome is associated with an increased risk of venous and arterial thromboembolism, which can be as high as 40% depending on the severity and underlying cause of nephrotic syndrome. The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend prophylactic anticoagulation only in idiopathic membranous nephropathy but acknowledge that existing data are limited and of low quality. There is a need for better identification of vulnerable patients in order to balance the risks of anticoagulation.
Methods:
We undertook a systematic search of the topic in MEDLINE, EMBASE and COCHRANE databases, for relevant articles between 1990 and 2019.
Results:
A total of 2381 articles were screened, with 51 full-text articles reviewed. In all, 28 articles were included in the final review.
Conclusion:
We discuss the key questions of whom to anticoagulate, when to anticoagulate, and how to prophylactically anticoagulate adults with nephrotic syndrome. Using available evidence, we expand upon current KDIGO guidelines and construct a clinical algorithm to aid decision making for prophylactic anticoagulation in nephrotic syndrome.
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