Recurrent venous thromboembolism in primary membranous nephropathy despite direct Xa inhibitor therapy.

Autor: Reynolds ML; Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. monica_reynolds@med.unc.edu.; UNC Kidney Center, 7024 Burnett-Womack, CB#7155, Chapel Hill, NC, 27599, USA. monica_reynolds@med.unc.edu., Nachman PH; Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN, USA., Mooberry MJ; Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Crona DJ; Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Derebail VK; Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2019 Aug; Vol. 32 (4), pp. 669-672. Date of Electronic Publication: 2018 Nov 12.
DOI: 10.1007/s40620-018-0552-9
Abstrakt: Clinically apparent venous thromboembolism (VTE) occurs in approximately 7% of patients with membranous nephropathy. Hypoalbuminemia at diagnosis is an independent risk factor for VTE, and risk increases significantly as albumin falls. Optimal prophylactic and treatment anticoagulation regimens in the nephrotic syndrome remain unproven but novel oral anti-coagulants have become attractive therapeutic options. We describe a patient diagnosed with anti-phospholipase A2 receptor antibody positive membranous nephropathy and recurrent VTE while on therapeutic dosing of apixaban. A direct factor Xa inhibitor, apixaban has been shown to be non-inferior to warfarin for the treatment of VTE in the general population. However, because it is highly protein-bound, apixaban may have altered pharmacokinetics and pharmacodynamics in patients with nephrotic syndrome and hypoalbuminemia. This case report highlights the need for further studies of direct oral anticoagulants to fully assess their effectiveness in this high-risk population.
Databáze: MEDLINE
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