Efficacy and Safety of Direct Oral Anticoagulants Versus Standard Anticoagulation for Thromboprophylaxis in Nephrotic Syndrome: A Systematic Review and Meta-Analysis.

Prophylactic anticoagulation (PAC) is used to reduce the risk of thrombosis in patients with nephrotic syndrome (NS), yet the optimal agent remains uncertain. This systematic review and meta-analysis compare the efficacy and safety of direct oral anticoagulants (DOACs) versus standard-of-care (SOC; heparins or cumarins) for thromboprophylaxis in NS. We systematically searched PubMed, Cochrane Library, Web of Science, and MEDLINE from inception to June 2025. Five cohort studies involving 399 adult patients were included. Pooled analysis indicated that while DOACs were associated with a higher risk of thrombotic events, they demonstrated a superior safety profile by significantly reducing the overall risk of bleeding events. The risk of major bleeding was comparable between the two strategies. These findings underscore the paramount importance of individualized risk-benefit assessment in clinical practice. The current evidence, derived from observational studies, calls for further validation from randomized controlled trials.