Cushing’s Syndrome, a Risk Factor for Venous Thromboembolism is a Candidate for Guidelines

Koraćević, Goran; Stojanović, Miloš; Petrovic, Slobodanka; Simić, Dušan; Sakač, Dejan; M, Vlajković; Stević, Miloš; Kocić, M.; Đorđević, Mirjana; Koraćević, Maja

doi:10.4183/aeb.2020.123

Cited by 4 publications

(6 citation statements)

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“…PE or DVT) both during the active phase of the disease, in postoperative setting, and even after biochemical remission [ 2 ]. There are currently no treatment studies on thromboprophylaxis of CS and no guidelines on the use of thromboprophylaxis for patients with CS, and therefore thromboprophylaxis management is committed to each center’s clinical practice [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, to date, there have been no prospective studies that have evaluated the effects of prophylactic anticoagulation on the occurrence of VTE in patients with CS, and consequently, evidence-based guidelines on thromboprophylaxis strategies in patients with CS are lacking [ 5 ]. Only retrospective series showing a decrease in VTE associated mortality and morbidity after the introduction of postoperative antithrombotic prophylaxis with unfractionated heparin followed by warfarin [ 6 ], low-molecular weight heparin with or without mechanical interventions [ 7 ], or aspirin [ 8 ] have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Current clinical practice for thromboprophylaxis management in patients with Cushing’s syndrome across reference centers of the European Reference Network on Rare Endocrine Conditions (Endo-ERN)

Haalen

Kaya

Pelsma

et al. 2022

Orphanet J Rare Dis

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Background Cushing’s syndrome (CS) is associated with an hypercoagulable state and an increased risk of venous thromboembolism (VTE). Evidence-based guidelines on thromboprophylaxis strategies in patients with CS are currently lacking. We aimed to map the current clinical practice for thromboprophylaxis management in patients with CS across reference centers (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN), which are endorsed specifically for the diagnosis and treatment of CS. Using the EU survey tool, a primary screening survey, and subsequently a secondary, more in-depth survey were developed. Results The majority of the RCs provided thromboprophylaxis to patients with CS (n = 23/25), although only one center had a standardized thromboprophylaxis protocol (n = 1/23). RCs most frequently started thromboprophylaxis from CS diagnosis onwards (n = 11/23), and the majority stopped thromboprophylaxis based on individual patient characteristics, rather than standardized treatment duration (n = 15/23). Factors influencing the initiation of thromboprophylaxis were ‘medical history of VTE’ (n = 15/23) and ‘severity of hypercortisolism’ (n = 15/23). Low-Molecular-Weight-Heparin was selected as the first-choice anticoagulant drug for thromboprophylaxis by all RCs (n = 23/23). Postoperatively, the majority of RCs reported ‘severe immobilization’ as an indication to start thromboprophylaxis in patients with CS (n = 15/25). Most RCs (n = 19/25) did not provide standardized testing for variables of hemostasis in the postoperative care of CS. Furthermore, the majority of the RCs provided preoperative medical treatment to patients with CS (n = 23/25). About half of these RCs (n = 12/23) took a previous VTE into account when starting preoperative medical treatment, and about two-thirds (n = 15/23) included ‘reduction of VTE risk’ as a goal of treatment. Conclusions There is a large practice variation regarding thromboprophylaxis management and perioperative medical treatment in patients with CS, even in Endo-ERN RCs. Randomized controlled trials are needed to establish the optimal prophylactic anticoagulant regimen, carefully balancing the increased risk of (perioperative) bleeding, and the presence of additional risk factors for thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current clinical practice for thromboprophylaxis management in patients with Cushing’s syndrome across reference centers of the European Reference Network on Rare Endocrine Conditions (Endo-ERN)

Haalen

Kaya

Pelsma

et al. 2022

Orphanet J Rare Dis

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“…It is particularly so if hypercortisolism is not controlled. Even following the effective therapy of CD (despite a decrease of BP and body mass index) the majority Reference confirming the rationale for the cited drug (or diagnostic procedure) for particular co-morbidity /characteristic HTN (early treatment) [5,6] RAAS blocker, spironolactone, consider timely (using ABPM) CCB, diuretic and BB [15,16] Hyperlipidemia (early treatment) [5] depending upon FHS or SCORE, consider statin [20][21][22] HF (primary prevention) [5,23] RAAS blocker, spironolactone [24,25] CAD (early diagnosis) [5,26,27] Pretest probability of CAD, ECG, exercise test, CT calcium score [28,29] CAD (primary prevention) [5,26,30] Consider aspirin and statin [29,31] Hypokalemia (early treatment) [32] spironolactone, RAAS blocker [33,34] VTE (early diagnosis) [35] Clinical prediction rule, D dimer, venous ultrasound [36,37] Legend: CS/CD -Cushing's syndrome/Cushing's disease; HTNarterial hypertension; RAASrenin-angiotensin-aldosterone system; ABPMambulatory blood pressure monitoring; CCB -calcium channel blocker; BBbeta-blocker; FHS -Framingham Risk Score; SCORE -Systematic COronary Risk Evaluation; HFheart failure; CADcoronary artery disease; CTcomputerized tomography; ECGelectrocardiogram.…”

Section: Arterial Hypertension (Htn) (Tablementioning

confidence: 99%

A Suggestion for Proactive Cardiologic Approach to Cushing’s Syndrome or Disease

et al. 2023

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Numerous studies and reviews agree about the increased cardiovascular risk in Cushing’s syn-drome. Therefore, the aim of the paper is to suggest a few common diagnostic and therapeutic cardiologic preferences for the majority of Cushing’s syndrome/Cushing’s disease (CS/CD) pa-tients which are not yet routine but have the rationale to become standard procedures. This may serve as an initial working document, to be improved by the experts in the field. A narrative review is used to present synthesis and deduction of several approaches in cardiology regarding the actu-al topic. Results are systematized as the risk factors or co-morbidities list (prevalent in CS/CD) coupled with current and adapted cardiologic suggestions for practice.

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confidence: 99%

“…Cushing syndrome (CS) is associated with an 18-fold higher risk of venous thromboembolism (VTE), mostly during the active phase of the disease, in the postoperative period after transsphenoidal surgery and adrenalectomy, but also after biochemical remission [1]. Although hypercoagulability in CS is attracting more and more attention, there are still no guidelines regarding a standardized anticoagulation regimen in patients with CS [2].…”

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confidence: 99%

Pulmonary embolism as the first manifestation of Cushing syndrome in a young woman

Minasyan¹,

Bryk-Wiązania

Hubalewska‐Dydejczyk

et al. 2022

Endokrynol Pol

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Cushing syndrome (CS) is associated with an 18-fold higher risk of venous thromboembolism (VTE), mostly during the active phase of the disease, in the postoperative period after transsphenoidal surgery and adrenalectomy, but also after biochemical remission [1]. Although hypercoagulability in CS is attracting more and more attention, there are still no guidelines regarding a standardized anticoagulation regimen in patients with CS [2].We present a case of a young woman diagnosed with CS in the course of pulmonary embolism (PE) event management. To the best of our knowledge, in the literature there are 5 cases of patients with CS whose first presentation was VTE [3][4][5][6].A 35-year-old woman with no significant past medical history, on combined oral contraceptive (COC), presented to the emergency department with acute dyspnoea. Laboratory tests showed an elevated D-dimer concentration (1.62 ug/mL, upper reference limit: 0.5 ug/mL). Computed tomography pulmonary angiography revealed peripheral PE (Fig. 1) and incidental left adrenal gland tumour [20 × 27 mm, precontrast 30 Hounsfield units (HU)] (Fig. 2). Clinically, she presented mild arterial hypertension and hypokalaemia. The COC was discontinued, while anticoagulation therapy (rivaroxaban in a dose of 15 mg twice daily for 3 weeks followed by 20 mg once daily) was initiated, along with antihypertensive treatment and potassium supplementation. The patient was referred to an endocrinologist. In the course of further investigation inherited and acquired thrombophilia were excluded.

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Cushing’s Syndrome, a Risk Factor for Venous Thromboembolism is a Candidate for Guidelines

Cited by 4 publications

References 50 publications

Current clinical practice for thromboprophylaxis management in patients with Cushing’s syndrome across reference centers of the European Reference Network on Rare Endocrine Conditions (Endo-ERN)

Current clinical practice for thromboprophylaxis management in patients with Cushing’s syndrome across reference centers of the European Reference Network on Rare Endocrine Conditions (Endo-ERN)

A Suggestion for Proactive Cardiologic Approach to Cushing’s Syndrome or Disease

Pulmonary embolism as the first manifestation of Cushing syndrome in a young woman

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