Rivaroxaban for management of venous thromboembolism in pediatric
nephrotic syndrome; a case report and review of literature
Thromboembolism is a major complication of nephrotic syndrome (NS).
Hypoalbuminemia, loss of anticoagulant proteins, increased procoagulant
proteins, hemoconcentration, and platelet activation contribute to a
hypercoagulable state. Despite being well-described, the optimal
management of thromboembolism in NS remains unclear. Rivaroxaban, a
direct factor-Xa inhibitor has recently been shown to be safe and
efficacious in treating pediatric venous thromboembolism but has not
been well studied in NS. We present an adolescent with steroid-dependent
NS, deep vein thrombosis and submassive pulmonary embolism successfully
treated with rivaroxaban. We perform a systematic review of the reported
safety and efficacy of direct factor-Xa inhibitor in this population.