Efficacy And Safety Of Indobufen In Preventing Thrombosis In Patients With Idiopathic Membranous Nephropathy

Objective: To observe the efficacy and safety of indobufen in patients with idiopathic membranous nephropathy.Methods: A total of fifty patients with idiopathic membranous nephropathy were convenient selected from March 2017 to March 2018 at Hebei Province General Hospital and randomly divided into two groups: indobufen group(n=25)and warfarin group(n=25).All patients were treated with hormone combined with cyclosporine for primary disease.Indobufen group was given 200 mg of indobufen orally,twice a day;the warfarin group was given warfarin 2.5 mg orally,once a day,while subcutaneous injection of low molecular weight heparin 5000 IU once a day,and the International Normalized Ratio(INR)was monitored.The dose was adjusted according to the INR value,and the low molecular weight heparin was stopped after maintaining the INR value between 2~3.The coagulation indexes were measured before medication,two weeks and four weeks after administration.The coagulation indexes include prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),Fibrinogen(FIB)and D-Dimer.The occurrence of thrombus or embolism,hemorrhage and other adverse events within three months after anticoagulation therapy were observed.After three months,all the patients were examined with ultrasonography to confirm if there were thrombi in lower extremities and double renal veins.Coagulation index,the occurrence of thromboembolism,bleeding,gastrointestinal reactions and other adverse events were compared before and after treatment between the two groups.Results:1.There was no significant difference between the two groups in age,24-hour urinary protein,serum albumin(ALB)and prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(FIB)and D-Dimer before administration in two groups(P > 0.05).2.Compared with the prior treatment,in indobufen group,there was no significant difference in prothrombin time,activated partial thromboplastin time,international normalized ratio,D-Dimer after two weeks treatment(P > 0.05),but fibrinogen was slightly lower than before medication(P < 0.05).Compared with the prior treatment,there was no statistical difference in prothrombin time,activated partial thromboplastin time,international normalized ratio after four weeks treatment(P > 0.05);fibrinogen and D-Dimer were significantly lower(P < 0.05).3.Compared with the prior treatment,in warfarin group,prothrombin time,activated partial thromboplastin time,international normalized ratio were significantly prolonged after two weeks and four weeks treatment(P < 0.05),fibrinogen and D-Dimer were lower(P < 0.05).4.Compared with the prior treatment,FIB and D-Dimer were decreased after 4 weeks in indobufen and Warfarin group,and there was no difference in two groups(P > 0.05).5.There was no thromboembolism in the two groups during the follow-up period of three months.Subcutaneous congestion was observed in one and two patients in indobufen and warfarin group respectively,and one patient occurred gingival bleeding in warfarin group.There was no significant difference between the two groups in incidence of bleeding events(P > 0.05).There were no obvious gastrointestinal and other adverse reactions in both groups.Conclusion:1.Indobufen prevent thrombus in patients with IMN effectively.2.Compared with warfarin,indobufen had less effect on PT and APTT,the risk of bleeding is not higher than that of warfarin.