Thrombo-prevention in membranous nephropathy: a new tool for decision making? (Commentary)

Thromboembolic events occur in primary membranous nephropathy, especially when serum albumin is less than 2.8?g/dl. In such patients, a conundrum arises concerning anticipated benefits and risks when a prophylactic oral anticoagulant is considered. Lee et al. describe a flexible Markov decision tree program to aid decision making. Its application to individual patients will probably be useful, but physicians will need to assess patients’ tolerance for the benefit-to-risk ratio, considering the many factors bearing on the risk of thromboembolic events and/or serious bleeding.