Risk/Benefit Calculus Application to Guide Clinician Decision-Making Regarding Prescription of Anticoagulants to Prevent Venous Thromboembolic Events (VTEs) in Patients with Primary Membranous Nephropathy

    1.) This application is intended to estimate the benefit, in terms of potential for prevention of venous thromboembolic events (VTEs), relative to the risk, in terms of bleeding, of prescribing prophylactic anticoagulation for patients with primary membranous nephropathy It is not intended for patients with other diseases, such as focal segmental glomerulosclerosis (FSGS), minimal change disease, IgA nephropathy, diabetic nephropathy or lupus nephritis. The decision analysis model of this risk/benefit application is based on user inputs related to a primary membranous nephropathy patient's levels of hypoalbuminemia.
    2.) This application is intended for use by clinicians. Any patient who makes direct use of this application should consult with a clinician about the meaning of application results received.
    3.) This application is not intended to be a substitute for professional advice, nor is it intended to be used as the sole basis for medical treatment. This application is intended solely to serve as a limited guide to independent clinical decision-making.
    4.) The decision analysis results upon which this application is based were not prospectively and clinically validated. This application is provided "as is" and "as available", without any warranty of any kind, express or implied. Without limiting the foregoing, to the fullest extent permissible under applicable law, the authors of this application disclaim any warranty that this application will be error-free, and disclaim any implied warranties of title, merchantability, fitness for a particular purpose or non-infringement. The authors do not make any representations about the accuracy, reliability, currency, completeness, usefulness, performance or suitability of this application for its intended use. YOU EXPRESSLY AGREE THAT YOUR USE OF THIS APPLICATION AND YOUR RELIANCE UPON ANY RESULTS THAT THIS APPLICATION MAY DELIVER IS AT YOUR SOLE RISK.
    5.) This application does NOT consider or include:
      A. The severity of VTE.
      B. Risk factors for VTE other than hypoalbuminemia in patients with primary membranous nephropathy (see Lionaki S et al. Clin J Am Soc Nephrol. 2012 Jan;7(1):43-51 and Barbour SJ et al. Kidney Int. 2012 Jan;81(2):190-5). These other factors could include smoking, exposure to oral contraceptives, cancer, immobilization, obesity, genetic predisposition to VTE or autoantibodies (e.g. anti-phospholipid antibodies). Clinicians should consider that patients with such risk factors may have a greater risk of VTE, and thus a greater benefit from prophylactic anticoagulation than predicted by this application.
      C. Risk factors for bleeding other than those identified by the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study (Fang MC et al. J Am Coll Cardiol. 2011 Jul 19;58(4):395-401), such as risk of falls, diet or concomitant medications. Clinicians should consider such additional factors in deciding whether to prescribe prophylactic anticoagulation.
      D. Prescription of anticoagulants other than warfarin with a target INR of 2-3. This application is not intended to be extrapolated to other anticoagulants or to a different target INR.
      E. The possibility that the presence of hypoalbuminemia may alter the patient's response to warfarin (including altering the risk of bleeding), and render the target range of INR more difficult to maintain.
    6.) The authors of this application make no representations about the accuracy, reliability, currency, quality, completeness, usefulness, or suitability of information provided via links to third party informational resources. You agree that your reliance on any such resources is at your sole risk.
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