What is your approach to systemic anticoagulation for patients with hypoalbuminemia and nephrotic syndrome secondary to a non-membranous nephropathy condition?
At what serum albumin level do you initiate prophylactic anticoagulation in a patient with low bleeding risk and nephrotic syndrome secondary to a non-membranous nephropathy condition?
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Patients with nephrotic syndrome (NS) and hypoalbuminemia have a several-fold higher risk of venous thromboembolism (VTE) than the general population and also a somewhat higher risk of arterial thromboembolism (ATE), such as MI and stroke. This risk seems to be higher in membranous nephropathy (MN) ...
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All nephrotic proteinuria is associated with increased risk of thrombosis, but membranous nephropathy in particular has the highest associated risk (see Barbour et al., PMID 21918501). In adults with non-membranous nephrotic syndrome, I reserve anticoagulation for patients with a history of venous t...
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Generally, I prefer AC for patients with serially declining albumin (usually <2.5 g/dL) and proteinuria >10 g/g, as well as other risk factors for thrombosis (NYHA 3/4, immobilization, factor 5 Leiden, AF, history of VTE, etc.). The question is how quickly I can get the patient in remission, and how...
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Generally I prefer AC for patients with serially dropping albumin (usually below 2.5 g/dl) and proteinuria>10 g/g and other reasons fo
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