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Hypercoagulability in Cushing's syndrome: past, present, future.

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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.