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
Bryk-Wiązania, Agata Hanna (University Hospital)
Minasyan, Mari (University Hospital)
Świątkowska-Stodulska, Renata (Medical University of Gdańsk)
Undas, Anetta (Jagiellonian University Medical College)
Hubalewska-Dydejczyk, Alicja (University Hospital)
Webb, Susan 1952- (Institut d'Investigació Biomèdica Sant Pau)
Valassi, Elena (Universitat Internacional de Catalunya)
Gilis-Januszewska, Aleksandra (University Hospital)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	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. 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. 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. 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.
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 ; Ectopic adrenocorticotropic hormone syndrome ; Thromboprophylaxis ; Thrombotic risk ; Venous thromboembolism
Publicat a:	Frontiers in endocrinology, Vol. 15 (2024) , p. 1350010, ISSN 1664-2392

DOI: 10.3389/fendo.2024.1350010
PMID: 38529392

15 p, 4.9 MB

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