High prevalence of venous thrombotic events in Cushing's syndrome: data from ERCUSYN and details in relation to surgery
Kristina Isand, Richard A. Feelders, Thierry Brue, Miklós Tóth, Timo Deutschbein, Martín Reincke, Michal Kršek, Alicia Santos, Frank Demtröder, Olivier Chabre, Christian J. Strasburger, Anna Aulinas Masó, Vallo Volke, Alberto M. Pereira, R Lohmann, Ignasi Gich Saladich, Ercusyn Study Group, Cláudia Amaral, Alberto Giacinto Ambrogio, Gloria Aranda, Maura Arosio, Maria Balomenaki, P. Beck-Peccoz, C Berr-Kirmair, Jérôme Bertherat, Marek Bolanowski, Jens Bollerslev, Brue Thierry, Helena Cardoso, Davide Carvalho, Francesco Cavagnini, P Ceccato, Olivier Chabre, P. Chanson, Emanuel Christ, F Demtröder Zentrum fur Endokrinologie, Judit Dénes, Timo Deutschbein, Christina Dimopoulou, Alexander Dreval, Michael Droste, J Duarte, Tina Dušek, Emre Ertürk, Johan Arild Evang, Christian Fajardo, Julia Fazel, Richard A. Feelders, Simona Fica, Rogelio García-Centeno, Ezio Ghigo, Miklós Góth, Yona Greenman, Ilana Halperin, Felicia A. Hanzu, A. R. M. M. Hermus, Gudmundur Johannsson, Erika Hubina, Peter Kamenický, A Kasperlik-Załuska, Jasmin Kirchner, Darko Kaštelan, Irina Komerdus, Ivana Kraljević, Michal Kršek, Aleksandra Kruszyńska, Cristina Lamas, Ioana Maria Lambrescu, Sean M. Lang, A Luger, Dominique Maiter, N Marpole, Sorina Martin, Monique Martinie, M J Martins Oliveira, O Moros, Romana T. Netea‐Maier, John Newell‐Price, Maria Orbetzova, Isabel Paiva, Francesca Pecori Giraldi, Juan Carlos Percovich, Alberto M. Pereira, Melissa R. Pfeiffer, James Pickel, Valdis Pīrāgs, Óskar Ragnarsson, Aura Reghină, Martín Reincke, Pedro Riesgo, Myron Roberts, S. H. P. P. Roerink, Chris Rowan, П. А. Руденко, Mariam Sahnoun, Javier Salvador, Alicia Santos, C Scaroni, Helga Ágústa Sigurjónsdóttir, Tanja Škorić Polovina
Abstract
OBJECTIVE: The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in patients included in the European Registry on Cushing's syndrome (ERCUSYN), compare their clinical characteristics with those who did not develop VTE and identify risk factors for VTE. DESIGN: A retrospective observational cohort study. METHODS: Data extraction from the registry was taken on February, 7, 2022. At the time there were 2174 patients diagnosed with Cushing's syndrome (CS) and 95 VTEs were reported in the database. RESULTS: Of 95 VTE events 70 (74%) were in pituitary-dependent CS patients, 12 (12.5%) in adrenal-dependant CS, 10 (10.5%) in ectopic CS, and 3 (3%) in CS due to other causes. Sex, 24-hour urinary free cortisol (UFC) value at diagnosis, as well as the number of operations remained statistically significant predictors of VTE. Of patients who were treated with at least one surgery, 12 (13%) VTE occurred before and 80 (87%) after the surgery. Nearly half of these VTEs occurred within six months since the operation (36; 45%). Over half of the centers that reported VTE did not routinely anticoagulate CS patients. Anticoagulation schemes varied widely. CONCLUSION: Patients with CS have an elevated risk of developing VTE for an extended period of time. From ERCUSYN cohort patients have higher risk for VTE if they need multiple surgeries to treat CS, are males and have high UFC values at the diagnosis of CS. Since there is no agreement on thromboprohpylaxis, a protocol for VTE prevention that is widely adopted appears to be necessary for patients with CS.