Approach to the patient with Cushing's syndrome: use of anticoagulation therapy
Isand, Kristina Wass, John Karavitaki, Niki Fleseriu, Maria Klok, Frederikus A Pereira, Alberto M
Isand, Kristina
Wass, John
Karavitaki, Niki
Fleseriu, Maria
Klok, Frederikus A
Pereira, Alberto M
Affiliation
North-Estonia Medical Foundation; Oxford University Hospitals NHS Foundation Trust; University of Birmingham; Birmingham Health Partners; University Hospitals Birmingham NHS Foundation Trust; Oregon Health & Science University; Leiden University Medical Center; Amsterdam University Medical Center; University of Amsterdam
Other Contributors
Publication date
2025-12-15
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
There is an increased awareness on the higher hypecoagulability risks in patients with Cushing's syndrome (CS) but management remains controversial. Here, we present four illustrative cases of CS that exemplify some "grey areas" on venous thromboembolism (VTE) prevention-when to start, how long to continue, what to use, and when to stop. The cases span: initiation of prophylaxis at diagnosis of active CS; periprocedural management around inferior petrosal sinus sampling; peri-operative prophylaxis after transsphenoidal surgery (TSS); and discontinuation decisions in medically controlled disease. We synthesise current evidence and expert practice and recommend considering low-molecular-weight heparin at diagnosis of active CS, continuing through surgery, and extending for approximately three months after biochemical remission in selected patients to address the highest-events risk window. Based on recent data, we discourage routine use of graduated compression stockings for VTE prevention. Though bleeding complications appear uncommon, they need to be carefully considered on an individualized basis. Finally, scenarios where prophylaxis can be safely discontinued once eucortisolaemia is achieved are outlined. This case-anchored framework translates heterogeneous data into actionable guidance and highlights priorities for prospective evaluation.
Citation
Isand K, Wass J, Karavitaki N, Fleseriu M, Klok FA, Pereira AM. Approach to the Patient with Cushing's Syndrome: Use of Anticoagulation Therapy. J Clin Endocrinol Metab. 2025 Dec 15:dgaf671. doi: 10.1210/clinem/dgaf671. Epub ahead of print.
Type
Article