Hypercoagulability in Cushing's syndrome: prevalence, pathogenesis and treatment

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R van der Pas1, F W G Leebeek, L J Hofland

  • 1Department of Internal Medicine, Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands. r.vanderpas@erasmusmc.nl

Clinical Endocrinology
|November 9, 2012
PubMed

Insights

Patients with Cushing's syndrome (CS) face a significantly higher risk of blood clots due to a hypercoagulable state. Effective treatment and sustained remission are crucial for resolving these risks.

Area of Science:

  • Endocrinology
  • Hematology
  • Cardiovascular Medicine

Background:

  • Cushing's syndrome (CS) is associated with increased cardiovascular disease and a hypercoagulable state.
  • Patients with CS exhibit a markedly elevated risk (over 10-fold) of venous thromboembolism (VTE).
  • Postoperative thrombosis risk in CS patients mirrors that of major orthopedic surgery.

Purpose of the Study:

  • To elucidate the mechanisms underlying hypercoagulability in Cushing's syndrome.
  • To assess the impact of surgical intervention on the hypercoagulable state.
  • To evaluate the potential need for thromboprophylaxis in active CS.

Main Methods:

  • Analysis of coagulation parameters in patients with Cushing's syndrome.
  • Evaluation of fibrinolytic capacity and clotting times.
  • Assessment of changes in hypercoagulability markers post-surgery.

Main Results:

  • Hypercoagulability in CS results from increased procoagulant factor production and impaired fibrinolysis.
  • Activated partial thromboplastin time is shortened, and clot lysis time is increased in CS patients.
  • These hemostatic abnormalities partially improve one year post-surgery but do not normalize.

Conclusions:

  • Sustained biochemical remission may be necessary to fully resolve the hypercoagulable state in CS.
  • Thromboprophylaxis is potentially warranted for active CS patients, particularly perioperatively.
  • Further research is required to establish optimal thromboprophylaxis strategies for CS.

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