Risks for arterial and venous thromboembolic events in nephrotic syndrome are increased with severe hypoalbuminemia and especially in patients with membranous nephropathy. If the risk of bleeding is perceived to be low, it would be reasonable to initiate prophylactic anticoagulation early in diagnosis for patients with membranous nephropathy who have serum albumin levels <2 to 2.5 g/dl. For those at high risk of bleeding, it may be prudent to avoid anticoagulation. In those with intermediate risk of bleeding, prophylaxis for those with serum albumin levels <2 would be considered reasonable. Aspirin may be an alternative in those who have higher albumin levels, and/or if there is a high perceived risk of arterial or venous thromboembolic events with high bleeding risk. Further increased risk of venous thromboembolic events with immobility, obesity, malignancy, recent surgery, pregnancy, medications, central venous catheters, or genetic predisposition would decrease the threshold to start prophylaxis.