Introduction: Nephrotic syndrome (NS) due to primary glomerulonephritis (GN) is associated with a markedly increased risk of venous thromboembolism (VTE) from hypercoagulability, endothelial dysfunction, and hypoalbuminemia.Prophylactic anticoagulation is often advised, traditionally using warfarin, which has limitations such as dietary restrictions, drug interactions, need for INR monitoring, and bleeding risk.Warfarin may also accelerate vascular calcification in chronic kidney disease.Apixaban, a direct oral anticoagulant (DOAC) selectively inhibiting factor Xa, offers predictable pharmacokinetics, fewer interactions, and lower bleeding risk.Additionally, DOACs may exert anti-inflammatory and antifibrotic effects.This study evaluated the efficacy, safety, and potential pleiotropic effects of apixaban compared with warfarin in patients with NS due to primary GN.Methods: In a prospective cohort study, 85 adults with biopsyconfirmed primary GN and eGFR >60 mL/min/1.73m 2 were enrolled.Forty-two received warfarin (INR 2.0-3.0) and 43 received apixaban 5 mg twice daily.Follow-up was 6 months.Serum creatinine, eGFR, total protein, albumin, and 24-h proteinuria were measured at baseline and follow-up.Serum and urinary interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF), and transforming growth factor-beta1 (TGF 1 ) were assessed via ELISA at baseline, 1, and 6 months.Efficacy was defined as absence of VTE; safety outcomes included bleeding events classified by severity.Results: No thromboembolic events occurred in either group.Minor bleeding was observed in 19% of warfarin vs 4.6% of apixaban patients (p=0.01).At 6 months, IL-6, TNF, and TGF 1 levels were significantly lower in the apixaban group (all p<0.05), with greater reductions from baseline.Urinary TGF 1 decreased by 57% with apixaban vs 14% with warfarin.Renal function remained stable in both groups, but apixaban recipients showed higher serum albumin and reduced proteinuria.Conclusion: Apixaban was as effective as warfarin for VTE prevention in NS due to primary GN and had fewer bleeding complications.Moreover, apixaban reduced pro-inflammatory and pro-fibrotic cytokines, suggesting benefits beyond anticoagulation.These findings indicate potential renal and vascular protective effects of DOACs in glomerular diseases, warranting confirmation in larger randomized trials.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
I. S. Mykhaloiko (Wed,) studied this question.