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
Autor/a
Bryk-Wiązania, Agata Hanna
Minasyan, Mari
Świątkowska-Stodulska, Renata
Undas, Anetta
Hubalewska-Dydejczyk, Alicja
Webb, Susan M.
Valassi, Elena
Gilis-Januszewska, Aleksandra
Fecha de publicación
2024ISSN
1664-2392
Resumen
Introduction: 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. Methods: 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. Results: 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. Summary: 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.
Tipo de documento
Artículo
Versión del documento
Versión publicada
Lengua
English
Materias (CDU)
61 - Medicina
Palabras clave
Síndrome de Cushing
Síndrome de l'hormona adrenocorticotròpica ectòpica
Tromboembolisme venós
Risc trombòtic
Tromboprofilaxi
Síndrome de Cushing
Síndrome de hormona adrenocorticotrópica ectópica
Tromboembolismo venoso
Riesgo trombótico
Tromboprofilaxis
Cushing's syndrome
Ectopic adrenocorticotropic hormone syndrome
Venous thromboembolism
Thrombotic risk
Thromboprophylaxis
Páginas
15
Publicado por
Frontiers Media
Colección
15
Publicado en
Frontiers in Endocrinology
Citación
Bryk-Wiązania, Agata Hanna; Minasyan, Mari; Świątkowska-Stodulska, Renata [et al.]. 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. Frontiers in Endocrinology, 2024, 15, 1350010. Disponible en: <https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1350010/full>. Fecha de acceso: 5 abr. 2024. DOI: 10.3389/fendo.2024.1350010
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Derechos
© 2024 Bryk-Wiązania, Minasyan, Świątkowska-Stodulska, Undas, Hubalewska-Dydejczyk, Webb, Valassi and Gilis-Januszewska. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Excepto si se señala otra cosa, la licencia del ítem se describe como http://creativecommons.org/licenses/by/4.0/