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Uptodate Reference Title
Approach to prophylactic anticoagulation in adults with nephrotic syndrome
Approach to prophylactic anticoagulation in adults with nephrotic syndrome
Our approach to prophylactic anticoagulation in patients with nephrotic syndrome is based upon the cause of nephrotic syndrome, the assessed bleeding risk of the patient, and the serum albumin concentration. There is no high-quality evidence to support these (or any other) serum albumin thresholds, and these thresholds are largely based upon data from existing observational studies as well as the clinical experience of the authors and editors of the associated UpToDate topic. Refer to UpToDate topics on hypercoagulability in nephrotic syndrome for more details.
LMW: low-molecular-weight. * Refer to UpToDate topics on contraindications to anticoagulation. ¶ Anticoagulation-associated bleeding risk can be estimated using prediction models such as the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk score or the HAS-BLED bleeding risk score. Refer to UpToDate topics on risk factors and prevention of bleeding with anticoagulants. Δ Initial dosing of LMW heparin for prophylactic anticoagulation in pregnant patients with nephrotic syndrome is the same as that used to treat venous thromboembolism in pregnant patients. Refer to UpToDate topics on the use of anticoagulants during pregnancy and postpartum. ◊ Initial dosing of LMW heparin and warfarin for prophylactic anticoagulation in nonpregnant patients with nephrotic syndrome is the same as that used to treat venous thromboembolism in the general population. LMW heparin should be used with caution in individuals whose kidney function is markedly reduced and/or unstable. Refer to UpToDate topics on initiation of anticoagulation for venous thromboembolism. § In nonpregnant patients with a cause of nephrotic syndrome other than membranous nephropathy who are at low to intermediate risk of anticoagulation-associated bleeding and who have a serum albumin between 2.0 and 2.9 g/dL, the decision to administer prophylactic anticoagulation should be made on a case-by-case basis. Some contributors to the associated topic would administer prophylactic antiplatelet therapy with aspirin. One contributor would administer LMW heparin or warfarin in patients with acute severe nephrotic syndrome due to minimal change disease. Refer to UpToDate topics on hypercoagulability in nephrotic syndrome. ¥ In nonpregnant patients with membranous nephropathy who are at intermediate risk of anticoagulation-associated bleeding and who have a serum albumin between 2.0 and 2.9 g/dL, the decision to administer prophylactic anticoagulation should be made on a case-by-case basis. There are insufficient data to support a particular therapeutic approach. Some contributors to the associated topic would administer prophylactic antiplatelet therapy with aspirin, while other contributors would administer LMW heparin or warfarin when the serum albumin is between 2.0 and 2.5 g/dL and would not administer anticoagulation when the serum albumin is between 2.6 and 2.9. Refer to UpToDate topics on hypercoagulability in nephrotic syndrome.
