Venous thromboembolism in Cushing syndrome: results from an EuRRECa and Endo-ERN survey
Por:
Cherenko, M, Appelman-Dijkstra, NM, Zurita, ALP, Biermasz, NR, Dekkers, OM, Klok, FA, Reisch, N, Aulinas, A, Biagetti, B, Cannavo, S, Canu, L, Detomas, M, Devuyst, F, Falhammar, H, Feelders, RA, Ferrau, F, Gatto, F, Grasselli, C, van Houten, P, Hoybye, C, Isidori, AM, Kyrilli, A, Loli, P, Maiter, D, Nowak, E, Pivonello, R, Ragnarsson, O, Steenaard, R, Unger, N, van de Ven, A, Webb, SM, Yeste, D, Ahmed, SF, Pereira, AM
Publicada:
1 jun 2024
Resumen:
Background Patients with Cushing syndrome (CS) are at increased risk of venous thromboembolism (VTE).Objective The aim was to evaluate the 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 the 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 to 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 with 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 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 six patients (2.7%), of which one was fatal: two long before CS diagnosis, two between diagnosis and surgery, and two postoperatively. 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.Conclusion 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.Significance statement The incidence rate of venous thromboembolism in our study cohort was 14.6 (95% CI 5.5; 38.6) per 1000 person-years. Notably, this survey showed that there is great heterogeneity regarding time of initiation and duration of thromboprophylaxis in expert centers throughout Europe.
Filiaciones:
Cherenko, M:
Leiden Univ, Med Ctr, Dept Med, Div Endocrinol, Leiden, Netherlands
Appelman-Dijkstra, NM:
Leiden Univ, Med Ctr, Dept Med, Div Endocrinol, Leiden, Netherlands
Zurita, ALP:
Leiden Univ, Med Ctr, Dept Med, Div Endocrinol, Leiden, Netherlands
Biermasz, NR:
Leiden Univ, Med Ctr, Dept Med, Div Endocrinol, Leiden, Netherlands
Dekkers, OM:
Leiden Univ, Med Ctr, Dept Med, Div Endocrinol, Leiden, Netherlands
Klok, FA:
Leiden Univ, Dept Med, Div Thrombosis & Haemostasis, Med Ctr, Leiden, Netherlands
Reisch, N:
Ludwig Maximilians Univ Munchen, LMU Univ Hosp, Dept Med 4, Munich, Germany
Aulinas, A:
Fundacio Gestio Sanitaria Hosp Santa Creu & St Pau, Dept Endocrinol, IR St Pau, Barcelona, Spain
IBERER Unit 747 ISCIII, Barcelona, Spain
Biagetti, B:
Hosp Univ Vall dHebron, Dept Endocrinol, Barcelona, Spain
Cannavo, S:
Univ Hosp AOU Policlin G Martino, Endocrine Unit, Messina, Italy
Canu, L:
Univ Hosp Florence Careggi, Florence, Italy
Detomas, M:
Univ Hosp Wurzburg, Dept Internal Med, Wurzburg, Germany
Devuyst, F:
Hop Univ Bruxelles, Hop Erasme, Dept Endocrinol, Brussels, Belgium
Falhammar, H:
Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden
Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden
Feelders, RA:
Erasmus MC, Div Endocrinol, Dept Internal Med, Rotterdam, Netherlands
Ferrau, F:
Univ Hosp AOU Policlin G Martino, Endocrine Unit, Messina, Italy
Gatto, F:
IRCCS Osped Policlin San Martino, Genoa, Italy
Grasselli, C:
AUSL IRCCS, Cardiovasc Med Unit, Reggio Emilia, Italy
van Houten, P:
Radboud Univ Nijmegen, Dept Internal Med, Div Endocrinol, Med Ctr, Nijmegen, Netherlands
Hoybye, C:
Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden
Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden
Isidori, AM:
Sapienza Univ Rome, Dept Expt Med, Rome, Italy
Kyrilli, A:
Hop Univ Bruxelles, Hop Erasme, Dept Endocrinol, Brussels, Belgium
Loli, P:
San Raffaele Vita Salute Univ, IRCCS San Raffaele Hosp Milan, Div Endocrinol, Milan, Italy
Maiter, D:
UCLouvain, Clin Univ St Luc, Dept Endocrinol, Brussels, Belgium
Nowak, E:
Ludwig Maximilians Univ Munchen, LMU Univ Hosp, Dept Med 4, Munich, Germany
Pivonello, R:
Univ Federico II Napoli, Dipartimento Med Clin & Chirurg, Sez Endocrinol Diabetol Androl & Nutr, Naples, Italy
Ragnarsson, O:
Univ Gothenburg, Inst Med OR, Sahlgrenska Acad, Wallenberg Ctr Mol & Translat Med, Gothenburg, Sweden
Steenaard, R:
Maxima MC, Dept Internal Med, Veldhoven, Netherlands
Unger, N:
Univ Hosp Essen, Dept Endocrinol Diabet & Metab, Essen, Germany
van de Ven, A:
Radboud Univ Nijmegen, Dept Internal Med, Div Endocrinol, Med Ctr, Nijmegen, Netherlands
Webb, SM:
Fundacio Gestio Sanitaria Hosp Santa Creu & St Pau, Dept Endocrinol, IR St Pau, Barcelona, Spain
IBERER Unit 747 ISCIII, Barcelona, Spain
Yeste, D:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Pediat Endocrinol Serv, Barcelona, Spain
Inst Carlos III, CIBER Enfermedades Raras, Madrid, Spain
Ahmed, SF:
Leiden Univ, Med Ctr, Dept Med, Div Endocrinol, Leiden, Netherlands
Univ Glasgow, Off Rare Condit, Glasgow, Scotland
Univ Glasgow, Royal Hosp Children, Dev Endocrinol Res Grp, Glasgow, Scotland
Pereira, AM:
Univ Amsterdam, Dept Endocrinol & Metab, Med Ctr, Amsterdam, Noord Holland, Netherlands
Green Accepted, gold
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