低分子肝素/华法林续贯拜阿司匹林预防肾病综合征静脉血栓栓塞的临床随访研究

Low molecular weight heparin/Warfarin continued to take Aspirin to prevent venous thromboembolism with nephrotic syndrome: a clinical follow-up study

目的 探讨低分子肝素/华法林续贯拜阿司匹林在肾病综合征中预防静脉血栓栓塞效果以及相关不良事件。方法 回顾性分析2014年7月-2019年6月原兰州军区兰州总医院收治的原发性肾病综合征患者,在基础治疗上给予低分子肝素/华法林续贯拜阿司匹林预防性抗凝治疗。随访静脉血栓栓塞事件及抗凝相关不良事件。结果 共纳入355例,膜性肾病156例(43.9%),微小病变性肾小球病65例(18.3%),系膜增生性肾小球肾炎69例(19.4%),局灶节段性肾小球硬化63例(17.7%),膜增生性肾小球肾炎2例(0.6%)。中位随访时间162周,中位抗凝时间69周。该方案启动1周后,无静脉血栓栓塞事件,2例(0.56%)因消化道大出血急诊住院,6例(1.69%)因月经增多致贫血,4例(1.13%)发生抗凝剂相关性肾病。。结论 低分子肝素/华法林续贯拜阿司匹林预防性抗凝治疗安全、有效,风险较低。

Objective Investigated the use of low molecular weight heparin/Warfarin continued with Aspirin to prevent venous thromboembolism in patients with the nephrotic syndrome and the occurrence of the adverse events. Methods A retrospective analysis was conducted of patients with the primary nephrotic syndrome admitted to the previous Lanzhou General Hospital of the Lanzhou Military Command from July 2014 to June 2019, who was given the anticoagulant therapy: low-molecular-weight heparin/Warfarin continued with Aspirin in addition to the basic treatment. Venous thromboembolism events and anticoagulant related adverse events were followed up. Results A total of 355 patients were followed up, including 156 cases(43.9%) of membranous nephropathy, 65 cases(18.3%) of minimal change disease, 69 cases(19.4%) of mesangial proliferative glomerulonephritis, 63 cases(17.7%) of focal segmental glomerulosclerosis, and 2 cases(0.6%) of membranoproliferative glomerulonephritis. The median follow-up time was 162 weeks, and the median anticoagulation time was 69 weeks. When this anticoagulation regimen was started, no venous thromboembolism event occurred one week after, 2 cases(0.56%) were hospitalized due to massive gastrointestinal bleeding, 6 cases(1.69%) developed anemia due to menstruation and 4 cases(1.13%) had anticoagulant related nephropathy. Conclusion Low molecular weight heparin/aarfarin continued with Aspirin to prevent venous thromboembolism with nephrotic syndrome is safe and effective, and has a low risk of hemorrhagic complications.