Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study
Introduction: 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...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-04-01
|
| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024925000671 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850223153914052608 |
|---|---|
| author | Caroline Arches Arwa Jalal-Eddine Dimitri Titeca-Beauport Myriam Dao Thierry Lobbedez Philippe Zaoui Christophe Masset Dominique Bertrand Khalil El Karoui Henri Brenier Hamza Sakhi Bastien Peiffer Vincent Audard Nizar Joher |
| author_facet | Caroline Arches Arwa Jalal-Eddine Dimitri Titeca-Beauport Myriam Dao Thierry Lobbedez Philippe Zaoui Christophe Masset Dominique Bertrand Khalil El Karoui Henri Brenier Hamza Sakhi Bastien Peiffer Vincent Audard Nizar Joher |
| author_sort | Caroline Arches |
| collection | DOAJ |
| description | Introduction: 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. Methods: 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. Results: 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. Conclusion: This study suggests that DOAC are safer and more effective than conventional anticoagulant strategies for both primary and secondary prophylaxis in patients with NS. |
| format | Article |
| id | doaj-art-4eedc1da79cb402c84c2686cd84fa6f9 |
| institution | OA Journals |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-4eedc1da79cb402c84c2686cd84fa6f92025-08-20T02:06:04ZengElsevierKidney International Reports2468-02492025-04-011041188119510.1016/j.ekir.2025.01.042Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective StudyCaroline Arches0Arwa Jalal-Eddine1Dimitri Titeca-Beauport2Myriam Dao3Thierry Lobbedez4Philippe Zaoui5Christophe Masset6Dominique Bertrand7Khalil El Karoui8Henri Brenier9Hamza Sakhi10Bastien Peiffer11Vincent Audard12Nizar Joher13Département de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris AP-HP, Créteil, France; Université Paris Est Créteil, Institut National de Recherche Médicale (INSERM) U88. Institut Mondor de Recherche Biomédicale (IMRB), Créteil, FranceService de Néphrologie, Hôpital Foch, Suresnes, FranceService de Néphrologie, CHU Amiens-Picardie, Amiens, France; Laboratoire MP3CV-EA7517, Université de Picardie Jules Verne, Amiens, FranceService de Néphrologie, CHU Necker-Enfants-Malades, Paris, FranceService de Néphrologie, CHU Caen-Normandie, Caen, FranceAssociation pour la Gestion de la Dialyse et des Usagersporteurs de maladies rénales chroniques Meylan, Université Grenoble Alpes, Grenoble, FranceService de Néphrologie, CHU de Nantes, Nantes, FranceService de Néphrologie, CHU Rouen, Rouen, FranceService de Néphrologie, CHU Tenon, Paris, FranceService de Néphrologie, CHU Rennes, Rennes, FranceDépartement de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris AP-HP, Créteil, France; Université Paris Est Créteil, Institut National de Recherche Médicale (INSERM) U88. Institut Mondor de Recherche Biomédicale (IMRB), Créteil, FranceDépartement Médico-Universitaire 'Médecine', AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, FranceDépartement de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris AP-HP, Créteil, France; Université Paris Est Créteil, Institut National de Recherche Médicale (INSERM) U88. Institut Mondor de Recherche Biomédicale (IMRB), Créteil, FranceDépartement de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris AP-HP, Créteil, France; Université Paris Est Créteil, Institut National de Recherche Médicale (INSERM) U88. Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France; Correspondence: Nizar Joher, Département de Néphrologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny 94010 Créteil, France.Introduction: 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. Methods: 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. Results: 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. Conclusion: This study suggests that DOAC are safer and more effective than conventional anticoagulant strategies for both primary and secondary prophylaxis in patients with NS.http://www.sciencedirect.com/science/article/pii/S2468024925000671bleedingdirect oral anticoagulantsnephrotic syndromethrombosis |
| spellingShingle | Caroline Arches Arwa Jalal-Eddine Dimitri Titeca-Beauport Myriam Dao Thierry Lobbedez Philippe Zaoui Christophe Masset Dominique Bertrand Khalil El Karoui Henri Brenier Hamza Sakhi Bastien Peiffer Vincent Audard Nizar Joher Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study Kidney International Reports bleeding direct oral anticoagulants nephrotic syndrome thrombosis |
| title | Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study |
| title_full | Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study |
| title_fullStr | Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study |
| title_full_unstemmed | Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study |
| title_short | Safety and Efficacy of Oral Direct Factor Xa Inhibitors in Patients With Nephrotic Syndrome: Results From a National Retrospective Study |
| title_sort | safety and efficacy of oral direct factor xa inhibitors in patients with nephrotic syndrome results from a national retrospective study |
| topic | bleeding direct oral anticoagulants nephrotic syndrome thrombosis |
| url | http://www.sciencedirect.com/science/article/pii/S2468024925000671 |
| work_keys_str_mv | AT carolinearches safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT arwajalaleddine safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT dimitrititecabeauport safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT myriamdao safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT thierrylobbedez safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT philippezaoui safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT christophemasset safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT dominiquebertrand safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT khalilelkaroui safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT henribrenier safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT hamzasakhi safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT bastienpeiffer safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT vincentaudard safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy AT nizarjoher safetyandefficacyoforaldirectfactorxainhibitorsinpatientswithnephroticsyndromeresultsfromanationalretrospectivestudy |