title: Personalized prophylactic anticoagulation decision analysis in patients with membranous nephropathy.
abstract: Primary membranous nephropathy is associated with increased risk of venous thromboembolic events, which are inversely correlated with serum albumin levels. To evaluate the potential benefit of prophylactic anticoagulation (venous thromboembolic events prevented) relative to the risk (major bleeds), we constructed a Markov decision model. The venous thromboembolic event risk according to serum albumin was obtained from an inception cohort of 898 patients with primary membranous nephropathy. Risk estimates of hemorrhage were obtained from a systematic literature review. Benefit-to-risk ratios were predicted according to bleeding risk and serum albumin. This ratio increased with worsening hypoalbuminemia from 4.5:1 for an albumin under 3 g/dl to 13.1:1 for an albumin under 2 g/dl in patients at low bleeding risk. Patients at intermediate bleeding risk with an albumin under 2 g/dl have a moderately favorable benefit-to-risk ratio (under 5:1). Patients at high bleeding risk are unlikely to benefit from prophylactic anticoagulation regardless of albuminemia. Probabilistic sensitivity analysis, to account for uncertainty in risk estimates, confirmed these trends. From these data, we constructed a tool to estimate the likelihood of benefit based on an individual's bleeding risk profile, serum albumin level, and acceptable benefit-to-risk ratio (www.gntools.com). This tool provides an approach to the decision of prophylactic anticoagulation personalized to the individual's needs and adaptable to dynamic changes in health status and risk profile.
authors: 1] UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [2] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea.
authors: Taewoo
authors: T
authors: Lee
authors: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Andrea K
authors: AK
authors: Biddle
authors: 1] UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [2] Laiko Hospital, Athens, Greece.
authors: Sofia
authors: S
authors: Lionaki
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Vimal K
authors: VK
authors: Derebail
authors: Division of Nephrology, Department of Medicine, University of Toronto, and Toronto Glomerulonephritis Registry, Toronto, Ontario, Canada.
authors: Sean J
authors: SJ
authors: Barbour
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Sameer
authors: S
authors: Tannous
authors: Division of Nephrology, Department of Medicine, University of Toronto, and Toronto Glomerulonephritis Registry, Toronto, Ontario, Canada.
authors: Michelle A
authors: MA
authors: Hladunewich
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Yichun
authors: Y
authors: Hu
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Caroline J
authors: CJ
authors: Poulton
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Shannon L
authors: SL
authors: Mahoney
authors: 1] UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [2] Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: J
authors: J
authors: Charles Jennette
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Susan L
authors: SL
authors: Hogan
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Ronald J
authors: RJ
authors: Falk
authors: Division of Nephrology, Department of Medicine, University of Toronto, and Toronto Glomerulonephritis Registry, Toronto, Ontario, Canada.
authors: Daniel C
authors: DC
authors: Cattran
authors: Division of Nephrology, Department of Medicine, University of Toronto, and Toronto Glomerulonephritis Registry, Toronto, Ontario, Canada.
authors: Heather N
authors: HN
authors: Reich
authors: UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors: Patrick H
authors: PH
authors: Nachman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D016013:Likelihood Functions; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D018579:Patient Selection; D057285:Precision Medicine; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D035501:Uncertainty; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants