Table 2.
Summary of the literature to date, which consists only of case reports
| Authors and reference | Anticoagulant used | Case details | Clinical course summary |
|---|---|---|---|
| Dupree and Reddy16 | Rivaroxaban | 18-yr-old female | Patient was nephrotic with renal vein thrombosis and was readmitted with PE on warfarin within therapeutic INR range (2.0−3.0). She was then transitioned to rivaroxaban and successfully treated for at least 6 months at the time of writing. |
| Shimada et al.15 | Edoxaban | 39-yr-old male; serum creatinine 0.83 mg/dl, 5.7 g proteinuria, serum albumin 26 g/dl, no kidney biopsy | Patient presented with pulmonary emboli on CT, and PE. Serum anti-thrombin III protein C and S were normal. Patient was initially treated with heparin and warfarin; 20 days later, he presented with new symptoms and new PE on CT; INR was 2.28 at the time. He commenced edoxaban, which treated the renal vein thrombosis and pulmonary emboli successfully. Approximately 9 months later was switched to aspirin 100 mg. |
| Sasaki et al.13 | Dabigatran | 35-yr-old Japanese male; ∼7.5 g proteinuria, serum albumin 18 g/dl, creatinine 0.96 mg/dl, membranous nephropathy | Patient presented with hemiparesis and cerebral infarct. Left carotid thrombus was detected, without atherosclerosis. He had a history of smoking. Initially he was treated with heparin and warfarin, but developed hepatitis from warfarin and so DOAC was contemplated. Dabigatran was used at a lower dose of 110 mg BD to reduce bleeding risk. |
| Conference proceedings | |||
| Basu et al.17 | Rivaroxaban | 21-yr-old female with presumed lupus nephritis, no biopsy | Patient had a pulmonary embolism 2 yr prior and developed inferior vena cava thrombus after 6 months of warfarin therapy. She was pregnant and so was switched to heparin. After pregnancy, she was started on rivaroxaban; 2 months later, she developed splenic infarcts while taking rivaroxaban. She was actively nephrotic at the time, with presumed lupus nephritis, and kidney biopsy was judged to be an excessive risk. No details were given about further treatment. The authors postulate that raised coagulation factor levels in NS might make anticoagulants ineffective. However, this is a complicated case, and the thrombotic risk of active systemic lupus may be different than in other forms of NS. |
| Han et al.19 | Rivaroxaban | 60-yr-old male; membranous nephropathy | Patient initially presented with PE and was discharged on rivaroxaban, prescribed 15 mg BD for 3 wk, followed by 20 mg OD. After 5 mo, he presented with new-onset renal vein thrombosis and pulmonary emboli and was switched to warfarin and the Ponticelli regimen. |
| Kamran et al.18 | Rivaroxaban | 34-yr-old male; membranous nephropathy | PE and myocardial infarction (NSTEMI) discharged on rivaroxaban but discontinued it after 1 wk; 2 mo later, he presented with left ventricular thrombus and bilateral renal infarcts. |
BD, twice daily; CT, computed tomography; DOAC, direct-acting oral anticoagulant; INR, international normalized ratio; NS, nephrotic syndrome; NSTEMI, non−ST-elevation myocardial infarction; OD, once daily; PE, pulmonary emboli;