FP195PROPHYLATIC ANTICOAGULATION IN NEPHROTIC SYNDROME PREVENTS THROMBOEMBOLIC COMPLICATIONS

Abstract

Introduction and Aims: Nephrotic syndrome (NS)isassociated with an increased risk of thromboembolic events (TE). There are no randomized studies to direct the use of prophylactic anticoagulation (PAC), and international guidelines suggesting prophylactic treatment in selected patients with NS based on mathematical calculations of risk and benefits. This study investigates the number and type of TE and hemorrhagic complications in NS patients treated with PAC and compared this to non-treated patients. Methods: In a retrospective analysis, we included incident patients diagnosed with NS consecutively from September 2006 to January 2012 at two Danish Renal Departments with different practices regarding the use of PAC. Inclusion criteria were a diagnosis of NS with a P-albumin < 30 g/L and a renal biopsy confirming glomerular disease and a follow up of at least three weeks. Exclusion criteria were age < 16 years, diabetic kidney disease, treatment with anticoagulants at onset of NS, and renal replacement therapy. Patients were grouped based whether they received PAC (other than low dose aspirin) or not. All TE and/or bleeding episodes were registered from patient records, and the latter divided into major (blood transfusion required) and minor bleedings (blood transfusion not required). Results: Seventy-nine patients were included in the analysis. Only P-albumin was significantly different between the PAC and non-PAC group (Table, p < 0.001). PAC involved either warfarin with bridging using low-molecular-weight heparin (LMWH), prophylactic dose LMWH, or therapeutic dose LMWH (Table). Eight and four patients in the PAC group experienced a second and a third relapse, respectively, of NS, which were treated with PAC. In four and three of these patients, respectively, the PAC treatment was different during relapse. None of the 44 patients treated with PAC had a TE; while four patients not receiving PAC experienced a TE (one pulmonary embolism (PE), one PE and deep vein thrombosis, one PE and renal vein thrombosis, and one stroke; P < 0.035 between groups). Two patients receiving PAC in combination with low dose aspirin had a major bleeding episode and tree patients receiving PAC alone had a minor bleeding. This was not statistically different from the non-PAC group, in which two patients had minor bleeding episodes (P = 0.45 between groups). Conclusions: PAC treatment was associated with a decreased risk of TE in patients with NS. A tendency towards a greater risk of bleeding episodes was identified in patients receiving PAC. Major bleedings was only observed in patients on concomitant anti-platelet treatment.