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Hypercoagulability in Cushing's syndrome: past, present, future
Amit Akirov1,2, Maria Fleseriu3
1Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
Archives of Endocrinology and Metabolism
|November 28, 2025
Summary
Patients with Cushing's syndrome face high venous thromboembolism risk due to hypercortisolism. Prophylaxis is recommended, but standardized protocols are needed for better prevention of deep vein thrombosis and pulmonary embolism.
Area of Science:
- Endocrinology
- Hematology
- Vascular Medicine
Background:
- Cushing's syndrome involves prolonged glucocorticoid excess, causing multisystem complications.
- Elevated venous thromboembolism (VTE) risk, including DVT and PE, is well-documented in Cushing's syndrome patients.
- Hypercortisolism induces a hypercoagulable state via endothelial dysfunction, increased procoagulant factors, impaired fibrinolysis, and venous stasis.
Purpose of the Study:
- To review the mechanisms linking Cushing's syndrome to VTE.
- To discuss current recommendations for thromboprophylaxis in Cushing's syndrome.
- To identify gaps in knowledge and suggest future research directions.
Main Methods:
- Review of epidemiological studies on VTE in Cushing's syndrome.
- Analysis of mechanisms contributing to hypercoagulability.
- Synthesis of current consensus recommendations for thromboprophylaxis.
Main Results:
- Cushing's syndrome significantly increases VTE risk, persisting even after biochemical remission.
- Common comorbidities like obesity, hypertension, and diabetes exacerbate thrombotic risk.
- Consensus guidelines recommend thromboprophylaxis for most patients, with LMWH as preferred anticoagulant.
Conclusions:
- Standardized thromboprophylaxis protocols are crucial due to variable clinical practice.
- Further research is needed on risk stratification, prophylaxis duration, and long-term outcomes post-remission.
- Investigating DOACs and personalized medicine approaches may improve VTE prevention in Cushing's syndrome.
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