Key result
Apixaban successfully treated multiple thrombosis associated with minimal change nephrotic syndrome without recurrence of gastrointestinal bleeding in an 86-year-old male.
Why the study?
Minimal change nephrotic syndrome carries a high risk of thrombosis along with peptic ulcer risk from high-dose steroids, presenting a therapeutic challenge for anticoagulation.
Case Report (n=1)
Apixaban may be a safe and effective anticoagulant for managing thrombosis in patients with nephrotic syndrome who are at high risk for gastrointestinal bleeding.
Apixaban managed thrombosis without rebleeding in this MCNS case after heparin-related bleed; hypothesis-generating and should not yet change practice.
【症例】86歳男性．1週間前から全身浮腫を認め，Alb 1.4 g/dL，尿蛋白5.81 g/日のネフローゼ症候群を呈し入院した．腎生検を施行し微小変化型ネフローゼ症候群（minimal change nephrotic syndrome： MCNS）と診断した．プレドニゾロンコハク酸エステルナトリウム70 mgを開始するも腎機能は増悪し，胸水貯留および肺水腫により第7病日より血液透析を開始した．左下肢静脈，右内頸静脈血栓に対してヘパリン投与開始後に十二指腸潰瘍出血を生じたため，同薬を中止して内視鏡的止血術を繰り返したが，一方で多発脳梗塞や左上腕静脈，左内頸静脈血栓を生じた．同時期に透析を離脱し，Cr 0.74 mg/dLまで改善した．アピキサバンに変更したところ，再出血なく経過した．第62病日に尿蛋白は陰性化した．MCNSは血栓リスクが高い疾患である一方，高用量ステロイドによる消化性潰瘍リスクも伴う．アピキサバンはネフローゼ症候群に合併した血栓症に対し，出血リスクを抑えつつ治療を行う際に有効かもしれない．
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Sekiguchi et al. (2025) conducted a case report in Minimal change nephrotic syndrome with multiple thrombosis and gastrointestinal bleeding (n=1). Apixaban was evaluated. Apixaban successfully treated multiple thrombosis associated with minimal change nephrotic syndrome without recurrence of gastrointestinal bleeding in an 86-year-old male.
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