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