BACKGROUND It has been recognized that primary membranous nephropathy (MN) is related to an increased risk for thromboembolic complications. However, the current evidence supporting prophylactic and therapeutic anticoagulation is too weak to better meet the clinical needs of this patient population. The present review provides some suggestions to guide the decision on anticoagulant management in primary MN patients with a high risk of thrombosis or with thromboembolic complication. MATERIALS AND METHODS We extracted relevant studies by searching the published literature using the Cochrane Library, Medline, PubMed and Web of Science from March 1968 to March 2018. Eligible publications included guidelines, reviews, case reports, and clinical trial studies that concerned the rational management of anticoagulation therapy in the primary MN population. The evidence was thematically synthesized to contextualize implementation issues. RESULTS It was helpful for clinicians to make a decision for personalized prophylactic aspirin or warfarin in primary MN patients when serum albumin was < 3.2 g/dl to prevent arterial and venous thromboembolic events (VTEs). The treatment regimen for thromboembolic complications (VTEs, acute coronary syndrome and ischemic stroke) in primary MN was almost similar to that for the general population with thromboembolic events. It is noteworthy that patients should continue the previous primary MN treatment protocol during the entire treatment period until they achieve remission, the protocol is complete and the underlying diseases resolve. CONCLUSION The utility of prophylactic aspirin or warfarin may have clinical benefits for the primary prevention of thromboembolic events in primary MN with hypoalbuminemia. It is necessary to perform large randomized controlled trials and to formulate relevant guidelines to support the present review.

中文翻译：

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原发性膜性肾病患者抗凝和抗血小板治疗的管理。

背景技术已经认识到，原发性膜性肾病（MN）与血栓栓塞并发症的风险增加有关。但是，目前支持预防性和治疗性抗凝的证据太弱，无法更好地满足该患者群体的临床需求。本综述提供一些建议，以指导高血栓形成或血栓栓塞并发症风险的原发性MN患者抗凝治疗的决策。材料和方法我们通过检索Cochrane图书馆，Medline，PubMed和Web of Science从1968年3月至2018年3月的文献来提取相关研究。符合条件的出版物包括与合理管理有关的指南，评论，病例报告和临床试验研究。原发性MN人群的抗凝治疗方法。证据是按主题进行综合的，以结合实施问题。结果当血清白蛋白<3.2 g / dl时，对于临床上的MN患者，临床医生做出个性化的预防性阿司匹林或华法林治疗有助于预防动脉和静脉血栓栓塞事件（VTE），这是有帮助的。原发性MN的血栓栓塞并发症（VTE，急性冠状动脉综合征和缺血性中风）的治疗方案与发生血栓栓塞事件的普通人群的治疗方案几乎相似。值得注意的是，患者应在整个治疗过程中继续进行先前的原发性MN治疗方案，直至达到缓解，方案完成且基础疾病得以解决。结论预防性阿司匹林或华法林的实用性对于一级预防低白蛋白血症原发性MN的血栓栓塞事件可能具有临床益处。有必要进行大型的随机对照试验并制定相关指南以支持本次审查。