The thrombotic risk in Cushing's syndrome-questions, answers, and the algorithm to consider in its assessment: part I-thrombotic risk not related to surgery
Por:
Bryk-Wiazania, AH, Minasyan, M, Swiatkowska-Stodulska, R, Undas, A, Hubalewska-Dydejczyk, A, Webb, SM, Valassi, E, Gilis-Januszewska, A
Publicada:
11 mar 2024
Resumen:
Introduction Recently, it has been reported that there is a great diversity in strategies used for thromboprophylaxis in patients with Cushing's syndrome (CS). An aim of this review was to discuss these practices in light of the existing data on the thrombotic risk in patients with CS and guidelines for medically ill patients.Methods The four relevant topics and questions on thrombotic risk in CS were identified. The current guidelines on prevention and diagnosis of venous thromboembolism (VTE) were reviewed for the answers. An algorithm to consider in the assessment of the thrombotic risk in patients with CS was proposed.Results To address both generic and CS-specific risk factors for VTE, the algorithm includes the stepwise approach consisting of Padua Score, urine free cortisol, and CS-VTE score, with no indication for routine thrombophilia testing in the prediction of an index VTE episode. Having confirmed VTE, selected patients require thrombophilia testing to aid the duration of anticoagulant treatment. The separate part of the algorithm is devoted to patients with ectopic adrenocorticotropic hormone syndrome in whom exclusion of VTE precedes introducing routine thromboprophylaxis to prevent VTE. The cancer-related VTE also prompts thromboprophylaxis, with the possible vessel invasion. The algorithm presents a unifactorial and multifactorial approach to exclude high-bleeding risks and safely introduce thromboprophylaxis with low-molecular-weight heparin.Summary Our article is the first to present an algorithm to consider in the thrombotic risk assessment among patients with Cushing's syndrome as a starting point for a broader discussion in the environment. A plethora of factors affect the VTE risk in patients with CS, but no studies have conclusively evaluated the best thromboprophylaxis strategy so far. Future studies are needed to set standards of care.
Filiaciones:
Bryk-Wiazania, AH:
Jagiellonian Univ Med Coll, Chair & Dept Endocrinol, Krakow, Poland
Univ Hosp, Dept Endocrinol Oncol Endocrinol & Nucl Med, Krakow, Poland
Minasyan, M:
Univ Hosp, Dept Endocrinol Oncol Endocrinol & Nucl Med, Krakow, Poland
Swiatkowska-Stodulska, R:
Med Univ Gdansk, Fac Med, Dept Endocrinol & Internal Med, Gdansk, Poland
Undas, A:
John Paul 2 Hosp, Krakow, Poland
Jagiellonian Univ Med Coll, Inst Cardiol, Dept Thromboembol Disorders, Krakow, Poland
Hubalewska-Dydejczyk, A:
Jagiellonian Univ Med Coll, Chair & Dept Endocrinol, Krakow, Poland
Univ Hosp, Dept Endocrinol Oncol Endocrinol & Nucl Med, Krakow, Poland
Webb, SM:
Hosp S Pau, Dept Endocrinol, Barcelona, Spain
St Pau Biomed Res Inst IIB St Pau, Res Ctr Pituitary Dis, Barcelona, Spain
Inst Salud Carlos III, Ctr Biomed Network Res Rare Dis CIBERER, Unit 747, Madrid, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Valassi, E:
Inst Salud Carlos III, Ctr Biomed Network Res Rare Dis CIBERER, Unit 747, Madrid, Spain
Hosp & Inst Recerca Germans Trias i Pujol, Serv Endocrinol, Badalona, Barcelona, Spain
Univ Int Catalunya UIC, Barcelona, Spain
Gilis-Januszewska, A:
Jagiellonian Univ Med Coll, Chair & Dept Endocrinol, Krakow, Poland
Univ Hosp, Dept Endocrinol Oncol Endocrinol & Nucl Med, Krakow, Poland
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