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)
van Haalen, F.M. (Leiden University Medical Center)
Kaya, M. (Leiden University Medical Center)
Pelsma, I.C.M. (Leiden University Medical Center)
Dekkers, O.M. (Leiden University Medical Center)
Biermasz, N.R. (Leiden University Medical Center)
Cannegieter, S.C. (Leiden University Medical Center)
Huisman, M.V. (Leiden University Medical Center)
van Vlijmen, B.J.M. (Leiden University Medical Center)
Feelders, R.A. (Erasmus University Medical Center)
Klok, F.A. (Leiden University Medical Center)
Pereira, A.M. (Leiden University Medical Center)
Stochholm, K. (Aarhus University Hospital (Aarhus, Dinamarca))
Fliers, E. (Amsterdam UMC. University Medical Center)
Castinetti, F. (Assistance Publique-Hôpitaux de Marseille)
Brue, T. (Assistance Publique-Hôpitaux de Marseille)
Bertherat, J. (Assistance Publique -Consortium Cochin. Robert Debré. Necker. St Antoine. La Pitié Salpétrière)
Scaroni, C. (Hospital-University of Padova)
Colao, A. (Azienda Ospedaliera Universitaria "Federico II")
Giordano, R. (Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino)
Druce, M.R. (Barts Health -NHS Foundation Trust)
Beckers, A. (Centre Hospitalier Universitaire de Liège)
Spranger, J. (Charité - Universitätsmedizin Berlin)
Driessens, N. (Cliniques Universitaires de Bruxelles -Hôpital Erasme)
Maiter, D. (UCL Cliniques Universitaires Saint-Luc)
Feldt-Rasmussen, U. (Copenhagen University Hospital)
Feelders, R. (Erasmus MC: University Medical Center Rotterdam)
Webb, S. M 1952- (Institut d'Investigació Biomèdica Sant Pau)
Dattani, M. (Ormond Street Hospital -NHS Foundation Trust)
Husebye, E. (Haukeland University Hospital (Bergen, Noruega))
Zilaitiene, B. (Lithuanian University of Health Sciences)
Gaztambide, S. (Hospital Universitario Cruces)
Gatto, F. (IRCCS Ospedale Policlinico San Martino)
Ferone, D. (IRCCS Ospedale Policlinico San Martino)
Persani, L. (University of Milan)
Chiodini, I. (University of Milan)
Höybye, C. (Karolinska Institutet (Estocolm, Suècia))
Biermasz, N.R. (Leiden University Medical Center)
Klok, F.A. (Leiden University Medical Center)
Dekkers, O.M. (Leiden University Medical Center)
Meijer, O.C. (Leiden University Medical Center)
Reincke, M. (Ludwig-Maximilian-University Munich)
Vila, G. (Medical University of Vienna)
Perry, C. (NHS Greater Glasgow and Clyde Board)
Heck, A. (Oslo University Hospital HF)
Stancampiano, M.R. (Scientific Institute San Raffaele)
van de Ven, A. (Radboud University Nijmegen Medical Centre -Including Amalia's Children Hospital)
Johannsson, G. (Sahlgrenska University Hospital)
Ragnarsson, O. (Sahlgrenska University Hospital)
Tóth, M. (Semmelweis University)
Volke, V. (Tartu University Hospital)
Toumba, M. (Aretaeio Hospital Nicosia)
Canu, Letizia (University of Florence)
Vojtková, J. (Jessenius Medical Faculty Comenius University)
Al-Mrayat, M. (University Hospital Southampton -NHS Foundation Trust)
Fassnacht, M. (University Hospital Würzburg)
Detomas, M. (University Hospital Würzburg)
Karavitaki, N. (Birmingham Health Partners)
van der Klauw, M.M. (University Medical Centre Groningen)
Groselj, U. (University Children's Hospital)
Elenkova, A. (Medical University Sofia)
Unuane, D. (UZ Brussels)
Universitat Autònoma de Barcelona

Data:	2022
Resum:	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. 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cushing's syndrome ; Endo-ERN survey ; Guidelines ; Hemostasis ; Hypercortisolism ; Thromboprophylaxis ; Venous thromboembolism
Publicat a:	Orphanet Journal of Rare Diseases, Vol. 17 Núm. 1 (december 2022) , p. 178, ISSN 1750-1172

DOI: 10.1186/s13023-022-02320-x
PMID: 35505430

12 p, 1.2 MB

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