Alberto Carlos Reino: Anticoagulation in Membranous Nephropathy – Albumin Is Not Enough
Alberto Carlos Reino, Nephrologist at Nefron SAS, shared on LinkedIn:
”Anticoagulation in Membranous Nephropathy: Albumin Is Not Enough
Yes, membranous nephropathy carries a high thrombotic risk — but serum albumin alone should not drive anticoagulation decisions.
A validated decision-analysis tool integrates both thrombotic and bleeding risk, incorporating age, kidney function, haemoglobin, bleeding history, dialysis status, and an explicit benefit–risk threshold (VTE prevented per major bleed).
This allows individualised, patient-centred decisions, rather than reflex anticoagulation.
According to KDIGO, prophylactic anticoagulation is reasonable only in patients with severe hypoalbuminemia and low bleeding risk.
Aspirin remains an option when bleeding risk is high.
Despite their popularity, DOACs remain insufficiently studied in nephrotic syndrome, where heavy proteinuria may alter both safety and efficacy.
Bottom line:
In MN, anticoagulation should be risk-stratified, evidence-based, and individualised — not protocol-driven.”
Find the Decision Analysis here.
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