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)
Por:
van Haalen F.M., Kaya M., Pelsma I.C.M., Cannegieter S.C., Huisman M.V., van Vlijmen B.J.M., Feelders R.A., Stochholm K., Fliers E., Castinetti F., Brue T., Bertherat J., Scaroni C., Colao A., Giordano R., Druce M.R., Beckers A., Spranger J., Driessens N., Maiter D., Feldt-Rasmussen U., Feelders R., Webb S.M., Dattani M., Husebye E., Zilaitiene B., Gaztambide S., Gatto F., Ferone D., Persani L., Chiodini I., Höybye C., Pereira A.M., Biermasz N.R., Klok F.A., Dekkers O.M., Meijer O.C., Reincke M., Vila G., Perry C., Heck A., Stancampiano M.R., van de Ven A., Johannsson G., Ragnarsson O., Tóth M., Volke V., Toumba M., Canu L., Vojtková J., Al-Mrayat M., Fassnacht M., Detomas M., Karavitaki N., van der Klauw M.M., Groselj U., Elenkova A., Unuane D.
Publicada:
1 ene 2022
Resumen:
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. © 2022, The Author(s).
Filiaciones:
van Haalen F.M.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Kaya M.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Pelsma I.C.M.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Cannegieter S.C.:
Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
Huisman M.V.:
Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
van Vlijmen B.J.M.:
Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
Feelders R.A.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Department of Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, Netherlands
Stochholm K.:
Department of Endocrinology, Aarhus University Hospital, Århus, Denmark
Department of Endocrinology
Fliers E.:
Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
Department of Endocrinology
Castinetti F.:
Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Department of Endocrinology
Brue T.:
Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Department of Endocrinology
Bertherat J.:
Department of Endocrinology
Scaroni C.:
Endocrinology Unit, Dep Medicine, DIMED, Hospital-University of Padova, Padua, Italy
Colao A.:
Department of Endocrinology
Department of Endocrinology, Azienda Ospedaliera Universitaria “Federico II”, Napoli, Italy
Giordano R.:
Department of Endocrinology
Department of Endocrinology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
Druce M.R.:
Department of Endocrinology
Department of Endocrinology, Barts Health -NHS Foundation Trust, London, United Kingdom
Beckers A.:
Department of Endocrinology
Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
Spranger J.:
Department of Endocrinology
Department of Endocrinology and Metabolic Diseases, Charité Universitätsmedizin, Berlin, Germany
Driessens N.:
Department of Endocrinology
Department of Endocrinology, Cliniques Universitaires de Bruxelles -Hôpital Erasme, Anderlecht, Belgium
Maiter D.:
Department of Endocrinology
Department of Endocrinology, UCL Cliniques Universitaires Saint-Luc, Brussels, Belgium
Feldt-Rasmussen U.:
Department of Endocrinology
Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Feelders R.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Department of Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, Netherlands
Webb S.M.:
Department of Endocrinology
Department of Endocrinology/Medicine, Fundacio de Gestio Sanitaria Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Dattani M.:
Department of Paediatric Endocrinology
Husebye E.:
Department of Endocrinology
Department of Endocrinology, Haukeland University Hospital, Bergen, Norway
Zilaitiene B.:
Department of Endocrinology
Department of Endocrinology, Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Gaztambide S.:
Hospital Universitario Cruces /Biocruces Bizkaia / EHU / CIBERDEM-CIBERER, Valencia, Spain
Gatto F.:
Department of Endocrinology
Department of Endocrinology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Ferone D.:
Department of Endocrinology
Department of Endocrinology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Persani L.:
Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano and BIOMETRA, University of Milan, Milan, Italy
Chiodini I.:
Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano and BIOMETRA, University of Milan, Milan, Italy
Höybye C.:
Department of Endocrinology
Department of Endocrinology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
Pereira A.M.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Biermasz N.R.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Klok F.A.:
Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
Dekkers O.M.:
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
Meijer O.C.:
Department of Endocrinology
Department of Endocrinology and Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
Reincke M.:
Department of Medicine IV, Ludwig-Maximilian-University Munich, Munich, Germany
Vila G.:
Department of Endocrinology
Department of Endocrinology and Metabolism, Medical University of Vienna, Center for Rare Endocrinologic Diseases, Vienna, Austria
Perry C.:
Department of Endocrinology
Department of Endocrinology, NHS Greater Glasgow and Clyde Board, Glasgow, United Kingdom
Heck A.:
Department of Endocrinology
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Oslo, Norway
Stancampiano M.R.:
Department of Pediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy
van de Ven A.:
Department of Endocrinology
Department of Endocrinology, Radboud University Nijmegen Medical Centre -Including Amalia’s Children Hospital, Nijmegen, Netherlands
Johannsson G.:
Department of Endocrinology
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
Ragnarsson O.:
Department of Endocrinology
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
Tóth M.:
Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
Volke V.:
Department of Endocrinology
Department of Endocrinology, Tartu University Hospital, Tartu, Estonia
Toumba M.:
Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
Department of Pediatrics, Pediatric Endocrinology Clinic, Aretaeio Hospital Nicosia, Nicosia, Cyprus
Canu L.:
Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
Vojtková J.:
Department of Pediatrics, University Hospital Martin, Jessenius Medical Faculty Comenius University, Martin, Slovakia
Al-Mrayat M.:
Department of Endocrinology
Department of Endocrinology, University Hospital Southampton -NHS Foundation Trust, Southampton, United Kingdom
Fassnacht M.:
Department of Endocrinology
Department of Endocrinology, University Hospital Würzburg, Würzburg, Germany
Detomas M.:
Department of Endocrinology
Department of Endocrinology, University Hospital Würzburg, Würzburg, Germany
Karavitaki N.:
Department of Endocrinology
Department of Endocrinology, University Hospital Southampton -NHS Foundation Trust, Southampton, United Kingdom
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
van der Klauw M.M.:
Department of Endocrinology
Department of Endocrinology, University Medical Centre Groningen, Groningen, Netherlands
Groselj U.:
Department of Endocrinology
Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, University Children’s Hospital, Ljubljana, Slovenia
Elenkova A.:
Department of Endocrinology
Department of Endocrinology, Medical University Sofia, USHATE “Acad. Ivan Penchev”, Sofia, Bulgaria
Unuane D.:
Department of Endocrinology
Department of Endocrinology, UZ Brussels, Jette, Belgium
All Open Access, Gold
|