The risk of thrombosis varies among the causes of nephrotic syndrome and appears to be highest in patients with membranous nephropathy (where recommendations tend to be most specific). Patients with minimal change disease are also at increased risk of thromboembolism. In addition, the risk of thrombosis is also related to the severity of hypoalbuminemia and tends to occur early in the course of the disease. Recommendations are all based on observational data and there is a lack of randomized trials – so these decisions should be individualized and weighed for each patient. For patients with membranous nephropathy, AC is recommended in: Patients with a low anticoagulation-associated bleeding risk and a serum albumin level <3.0 g/dL AND Patients with a low or intermediate anticoagulation-associated bleeding risk and a serum albumin level <2.0 g/dL. UNC has an online decision tool linked below that takes into account a few factors in weighing risks vs benefits! In patients with a cause of nephrotic syndrome other than membranous nephropathy, AC is recommended in patients with a low or intermediate anticoagulation-associated bleeding risk, and a serum albumin of <2.0 g/dL. The duration of AC is not well-defined, but some recommend continuing until the nephrotic syndrome is in remission or the albumin is >3.0. The experts still generally recommend LMWH or warfarin, with DOACs less understood in this pathology.
References: Prophylactic Anticoagulation in Patients with Membranous Nephropathy