Assessing the Risk of Thromboembolic Events and the Role of Prophylactic Anticoagulation in Saudi Patients with Primary Nephrotic Syndrome

Background: Studies have shown that risk of thromboembolism in nephrotic Syndrome varies from 7-40%. Membranous nephropathy has been shown to have the highest risk. Methods: A retrospective cohort study using data from electronic medical records from January 2011 until December 2022.The study included patients with biopsy-proven minimal change disease (MCD), FSGS, membranous nephropathy, and IgA nephropathy with nephrotic syndrome. Results: Among 169 patients with nephrotic syndrome, thromboembolism was observed in 9.47 % of cases. Membranous and IgA nephropathies showed the highest incidence at 12.8 % and 10%, respectively. The thromboembolism percentages across the groups was not statistically significant (p=0.772).The vast majority (94%) were not on any anticoagulant therapy, and they had thromboembolic events at a rate of 9.4%. One patient on warfarin had thromboembolic event, while no events were reported among users of Apixaban, Heparin, or Enoxaparin. The association between anticoagulant use and thromboembolic events was not statistically significant (p = 0.88).Among patients who had thromboembolic events, 62.5% had albumin <20 g/L. Conclusion: Thromboembolic risk is about 9.4% among Saudi patients with nephrotic syndrome with membranous nephropathy representing the highest risk. Anticoagulation is effective in reducing the risk. We noted no significant difference in reducing thromboembolic risk among different classes of anticoagulants. - Anticoagulant No Thromboembolism Thromboembolism Total None 14490.57 159.43 159100.00 Warfarin 480.00 120.00 5100.00 Apixaban 2100.00 00.00 2100.00 Heparin 2100.00 00.00 2100.00 Enoxaparin 1100.00 00.00 1100.00 Total 15390.53 169.47 169100.00 Pearson chi2 (4)= 1.1702 Pr- 0.883