Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National...

The optimal management of thromboembolism (TE) in patients with nephrotic syndrome (NS) remains challenging. Until now, anticoagulation therapy for NS consisted of vitamin K antagonists (VKAs) or heparin. Data on direct oral anticoagulant (DOAC) use in NS are limited, and their safety and convenience have been well-demonstrated in other indications.

We conducted a multicenter retrospective study of adult patients with NS treated with therapeutic-dose anticoagulation between 2014 and 2022. We compared the incidences of bleeding and TE events between patients receiving DOAC and those receiving VKAs or heparin (standard-of-care [SOC]). Patients with end-stage kidney disease were excluded.

The overall population consisted of 144 patients (median [interquartile range] age of 54 [38-67] years, 34.7% women) with a median albumin level at 1.5 (1.2-1.8) g/dl and a median urinary protein-to-creatinine ratio of 8.8 (5.5-12.3)g/g. Membranous nephropathy was the main NS etiology (45.8%). No significant differences were observed between the DOAC (n = 72) and the SOC (n = 72) groups. The anticoagulant strategy was primary prophylaxis in 79.2% of patients taking DOAC and 83.3% of patients with SOC (P = 0.67). DOAC use was not associated with an increased rate of TE (4.2% vs. 0%, P = 0.25) or bleeding events (6.9% vs. 13.9%, P = 0.28) compared with the SOC group. Univariate analysis identified female sex, age > 75 years, and anticoagulant exposure > 90 days as risk factors for bleeding.

This study suggests that DOAC are safer and more effective than conventional anticoagulant strategies for both primary and secondary prophylaxis in patients with NS.