Hypercoagulable State in Cushing’s Syndrome: A Systematic Review

Abstract

Available studies suggest a high risk of venous thrombosis in patients with Cushing's syndrome. Glucocorticoid-induced hypercoagulability as well as surgery and obesity almost certainly contribute to this thrombotic tendency.

Hemostatic abnormalities in endocrine and metabolic disorders

“…The authors confirmed that there is an increased risk of unprovoked and post-operative venous thromboembolism in patients with Cushing's syndrome (82). Glucocorticoid-induced hypercoagulability as well as surgery and obesity, conditions that are commonplace in patients with Cushing's syndrome, almost certainly contributes to this prothrombotic tendency.…”

“…Thus, future larger clinical and intervention studies are required to provide more definitive information on the clinical relevance and the effects of the pharmacologic treatment of the hormonal dysfunction on the abnormalities of coagulation and fibrinolysis in these endocrine disorders. At present, there is a general agreement that a high risk of venous thromboembolism is present in patients with active Cushing's syndrome, and that thromboprophylaxis with low-molecular-weight heparin should be (routinely) considered in patients with this disorder undergoing surgery (82). Although the available data are controversial and more extensive studies are necessary, prophylactic anticoagulation might be also recommended in older patients with hyperthyroidism and atrial fibrillation in the presence of other heart disease, hypertension, or other important risk factors for embolization (148).…”

“…In this review, it was also reported that no univocal statistical differences in plasma hemostatic markers can be found between patients with active Cushing's syndrome and those in remission. Likewise, no clear difference was observed for subclinical Cushing's syndrome due to adrenal adenomas (82). In the absence of prospective randomized clinical trials, there is currently a general agreement that thromboprophylaxis should be routinely used in patients with active Cushing's syndrome undergoing transsphenoidal or adrenal surgery.…”

D-dimer as a significant marker of deep vein thrombosis in patients with subclinical or overt Cushing’s syndrome

“…To prevent VTE in these patients, early VTE (particularly DVT) screening and diagnosis are very important [10,11]. VTE is a frequent complication in patients with CS, especially during and after surgery [2,3], and thromboprophylaxis has been recommended for patients with active CS. However, thromboprophylaxis carries some inherent risks such as bleeding events.…”

Cardiovascular complications of cushing’s syndrome

“…Non provoked venous thromboembolism risk is doubled in CS. Risk of postoperative venous thromboembolism is varied between 0 and 5.6% (43). High levels of fibrinogen, factor VIII, factor IX, von Willebrand factor and the evidence of enhanced thrombin generation are the suggested reasons for glucocorticoid induced hypercoagualopathy.…”