Venous Thromboembolism Prevention in Nephrotic Syndrome: The Role of Aspirin, Vitamin K Antagonists, and Direct Oral Anticoagulants

Nephrotic syndrome (NS) is associated with a significantly elevated risk of venous thromboembolic events (VTEs), which contribute to morbidity and mortality. Current guidelines for VTE prophylaxis in patients with NS are based on limited evidence, primarily from observational studies. This review describes the complexities of hypercoagulability in NS, with a focus on aspirin as a potential prophylactic agent. We outline the pathophysiology underlying VTE in NS, highlighting factors such as hypoalbuminemia, anticoagulant loss, and heightened platelet reactivity. This review also summarizes the available data on the role of aspirin in reducing thromboembolic risk. Although aspirin may benefit select patient groups, its efficacy remains inconclusive, with some studies suggesting a combination of aspirin and anticoagulants for more effective risk reduction. Future studies, particularly large-scale randomized controlled trials (RCTs), are necessary to clarify the role of aspirin in preventing VTEs in this population. Our review underscores the need for individualized prophylactic strategies that balance thrombotic and bleeding risks in patients with NS.