Aim: to assess the efficacy and safety of apixaban in preventing thromboembolic complications in patients with nephrotic syndrome (NS) due to primary glomerulonephritis, and to investigate its potential anti-inflammatory and antifibrotic effects.

Materials and methods. A prospective longitudinal cohort study included 85 adult patients with newly diagnosed NS and estimated glomerular filtration rate >60 mL/min/1.73 m2. Patients were divided into two groups: 42 received warfarin and 43 received apixaban (5 mg twice daily). The follow-up period was 6 months. IL-6, TNFα, and TGF-β1 were measured in serum and urine at baseline, 1 month, and 6 months.

Results. No thromboembolic events occurred in either group. Minor bleeding events were significantly more common in the warfarin group (p = 0.01), confirming apixaban’s better safety profile. After 6 months, the apixaban group showed a more pronounced decrease in IL-6, TNFα, and TGF-β1 levels in both serum and urine compared to the warfarin group (p < 0.05), suggesting anti-inflammatory and antifibrotic effects potentially associated with protease-activated receptor pathway modulation.

Conclusions. Apixaban ensures safe and effective thromboprophylaxis in NS with possible additional benefits in reducing inflammation and fibrosis. Further studies are needed to confirm these effects and define its role in nephrology.