Venous thromboembolism chemical prophylaxis after endoscopic trans-sphenoidal pituitary surgery

Waqar, Mueez; Chadwick, Angelina; Kersey, James P.; Horner, Daniel; Kearney, Tara; Karabatsou, Konstantina; Gnanalingham, Kanna; Pathmanaban, Omar

doi:10.1007/s11102-021-01195-8

Cited by 6 publications

(8 citation statements)

References 29 publications

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“…44 Therefore, giving thromboprophylaxis during active disease and/or post-operatively remains an individual decision and should be taken into account. According to a study by Waqar et al 47 , chemoprophylaxis with tinzaparin reduced the risk for post-operative VTEs without an increased risk for significant bleeding events.…”

Section: Thromboembolismmentioning

confidence: 99%

Long‐term morbidity and mortality in patients with Cushing's syndrome

Braun

Vogel

Reincke

2022

J Neuroendocrinology

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Increased multisystem morbidity and mortality in patients with Cushing's syndrome comprise clinical problems and challenges, both at the time of diagnosis and in remission. Relevant comorbidities and clinical problems include hypertension, diabetes, overweight, myopathy and a high risk for acute complications such as infections and venous thrombembolism. Although there are therapy recommendations for most of these comorbidities, there is a lack of large, prospective studies to confirm and optimise them. Mortality is especially high during active disease and within the first year after diagnosis, as a result of cardiovascular events, infections and suicide. All in all, interdisciplinary therapy management is important for reducing morbidity and mortality over the long‐term.

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Section: Thromboembolismmentioning

confidence: 99%

Long‐term morbidity and mortality in patients with Cushing's syndrome

Braun

Vogel

Reincke

2022

J Neuroendocrinology

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“…A specific thromboprophylaxis protocol for patients with CS was not available in the vast majority of centers, despite the fact that retrospective cohort studies have shown a decrease in VTE-associated mortality and morbidity in patients with endogenous hypercortisolism on anticoagulant treatment ( 20 , 21 ). Thromboprophylaxis in CS patients has been reported to be associated with low bleeding rates ( 22 , 23 ), which is confirmed in the present study.…”

Section: Discussionmentioning

confidence: 94%

Venous thromboembolism in Cushing syndrome: results from an EuRRECa and Endo-ERN survey

Cherenko,

Appelman-Dijkstra,

Priego Zurita

et al. 2024

Endocrine Connections

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Background: Patients with Cushing syndrome (CS) are at increased risk of venous thromboembolism (VTE). Objective: To evaluate current management of new cases of CS with a focus on VTE and thromboprophylaxis. Design and Methods: A survey was conducted within those that report in electronic reporting tool (e-REC) of The European Registries for Rare Endocrine Conditions (EuRRECa) and the involved main thematic groups (MTG’s) of the European Reference Networks for Rare Endocrine Disorders (Endo-ERN) on new patients with CS from January 2021 until July 2022. Results: Of 222 patients (mean age 44 years, 165 females), 141 patients had Cushing disease (64%), 69 adrenal CS (31%) and 12 patients ectopic CS (5.4%). The mean follow-up period post CS diagnosis was 15 months (range 3-30). Cortisol lowering medications were initiated in 38% of patients. One hundred and fifty-four patients (69%) received thromboprophylaxis (including patients on chronic anticoagulant treatment), of which low-molecular weight-heparins were used in 96% of cases. VTE was reported in 6 patients (2.7%), of which 1 was fatal: 2 long before CS diagnosis, 2 between diagnosis and surgery and 2 post-operatively. Three patients were using thromboprophylaxis at time of the VTE diagnosis. The incidence rate of VTE in patients after Cushing syndrome diagnosis in our study cohort was 14.6 (95% CI 5.5; 38.6) per 1000 person-years. Conclusions: Thirty percent of patients with CS did not receive preoperative thromboprophylaxis during their active disease stage and half of the VTE cases even occurred during this stage despite thromboprophylaxis Prospective trials to establish the optimal thromboprophylaxis strategy in CS patients are highly needed.

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“…10,11 Based on the elevated VTE risk after TSS for CD, it appears that chemoprophylaxis postoperatively in addition to me-chanical prophylaxis is warranted. 3,10,11,20 Based on prior data, it appears that starting subcutaneous heparin within 24 hours postoperatively carries low risk of sellar hematoma or epistaxis. However, the total duration of chemoprophylaxis (e.g., in-hospital only, 7, 14, or 28 days) remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

White,

Almeida,

Petitt

et al. 2023

J Neurol Surg B Skull Base

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Introduction Cushing's disease (CD) is associated with hypercoagulability which is associated with an increased risk of venous thromboembolic events (VTEs) perioperatively. This risk persists even after successful transsphenoidal surgery (TSS). However, there are no current guidelines for pharmacologic thromboprophylaxis in this patient population. Objective Characterize existing thromboprophylaxis management practices in patients undergoing TSS for CD. Methods An anonymous RedCap survey comprised of questions about perioperative thromboprophylaxis in CD patients was distributed via the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Tumor Section and the North American Skull Base Society (NASBS) email lists. Results The survey was distributed to 554 members of the AANS/CNS Joint Tumor Section and 1,094 members of NASBS asking that members who surgically treat CD respond. Sixty responses (3.0% response rate) were received. Fifty-two (86.7%) respondents are involved in the postoperative management of CD patients. Thirty-six (69.2%) treat all patients with postoperative VTE chemoprophylaxis, 8 (15.4%) treat some patients, while 8 (15.4%) do not use chemoprophylaxis. Preferred chemoprophylaxis varies as 26 (59.1%) administer low molecular weight heparin, 14 (31.8%) give unfractionated heparin, 1 (2.3%) give direct oral anticoagulants, and 3 (6.8%) give aspirin. Most (28, 53.8%) of the respondents perceive the VTE risk in this patient population to be 0 to 5%, 16 (30.8%) perceive the risk to be 6 to 10%, and 8 (15.4%) perceive it to be 11 to 20%. Conclusion There is great variability in VTE detection and postoperative prevention practice patterns in CD patients. This study highlights the need for prospective studies to clarify optimal pharmacologic chemoprophylaxis strategies and duration in this patient population.

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Venous thromboembolism chemical prophylaxis after endoscopic trans-sphenoidal pituitary surgery

Cited by 6 publications

References 29 publications

Long‐term morbidity and mortality in patients with Cushing's syndrome

Long‐term morbidity and mortality in patients with Cushing's syndrome

Venous thromboembolism in Cushing syndrome: results from an EuRRECa and Endo-ERN survey

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

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