PB1356 - Efficacy and safety of prophylactic anticoagulation in adult and children patients with primary nephrotic syndrome: a systematic review and meta-analysis

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Federica De Pascali, MD

Internal Medicine Resident
University of Insubria
Como, Lombardia, Italy

Co-Author(s)

FB

Francesca Brunini

MD
Nephrology Unit, ‘Ospedale di Circolo’, ASST Settelaghi, Varese, Italy
Varese, Lombardia, Italy
GR

Giuseppe Rombolà

MD
Nephrology Unit, ‘Ospedale di Circolo’, ASST Settelaghi, Varese, Italy
Varese, Lombardia, Italy
Alessandro Squizzato

Professor of Internal Medicine, Head of the Internal Medicine ward ASST Lariana, San Fermo
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Como, Lombardia, Italy

Background: Nephrotic Syndrome (NS) in a disease associated with an increased incidence of venous thromboembolic events (VTE), approximately 10%. There are no solid recommendations about the best prevention strategy for VTE in NS.

Aims: To evaluate the efficacy and safety of prophylactic anticoagulation in patients with NS.

Methods: Studies evaluating prophylactic anticoagulation in NS were identified by electronic search of MEDLINE and EMBASE database until December 2021. Weighted mean proportion and 95% confidence intervals (CIs) of thromboembolic and hemorrhagic events were calculated using a fixed-effects and a random-effects model. Statistical heterogeneity was evaluated using the I2 statistic. The difference in the thrombotic events among groups were estimated as pooled odds ratio (OR) and corresponding 95% confidence interval (CI).

Results: Five cohort studies, for a total of 414 adult patients, were included. All the studies were at high risk of bias. Only two study had a control group. Weighted mean incidence of pulmonary embolism and deep vein thrombosis in patients who received VTE prophylaxis was 1.8% (95% CI 0.6-3.5%; I2 4.4%) and 0.9% (95% CI 0.2-2.2%; I2 43.4%%) at fixed-effect model, respectively; no patient developed renal vein thrombosis. Weighted mean incidence of major bleeding in patients who received VTE prophylaxis was 2.3% (95% CI 1-4.2%; I2 25.4%) at random-effect model, respectively. Patients who received VTE prophylaxis had a non-statistically significant reduced risk of pulmonary embolism [OR 0.59 (CI 95% 0.13-2.65; I2 64.4%)], and an increased risk of major bleedings [OR 2.08 (CI 95% 0.41-10.45; I2 0%)] compared to whom did not received it.

Conclusion(s): Our findings suggest that prophylactic anticoagulation in adult patients with primary NS may reduce the risk of VTE, even if it may be associated with a not negligible bleeding risk.