Endocrine Abstracts

Background: Cushing’s syndrome (CS) is estimated to have a 10-fold increased risk of venous thromboembolism (VTE) compared with the normal population with VTE accounting for 3.6-11% deaths in CS patients. There are no specific guidelines for VTE prophylaxis in CS other than that it should be considered given the increasingly recognised risk.

Methods: Via the Society for Endocrinology, we surveyed current VTE anticoagulation practice across UK Endocrinology centres.

Results: 50/129 centres participated in the online survey. Less than half (48%) anticoagulated CS patients with the rest (26/50) stating they did not routinely anticoagulate at any point in the management pathway. In those centres that did anticoagulate, practice varied across patient selection, type of anticoagulation administered, timing of initiation of anticoagulation and the duration of anticoagulation. Seven centres anticoagulated for the duration of hypercortisolaemia, 66,7% anticoagulated perioperatively and 2 centres did not specify their thromboprophylaxis regime. Most of the centres that anticoagulated, did so for both adrenal and pituitary origin Cushing’s patients (19/26 centres); 4 centres anticoagulated only pituitary origin, none anticoagulated adrenal Cushing’s only. 26% use mechanical thromboprophylaxis (stockings) routinely. The duration of anticoagulation varies widely ranging from hospital stay until 12 weeks post-operatively. Most centres (24/26) use LMWH at a prophylactic dose, but 2 centres use Rivaroxaban. 30% of centres have changed their anticoagulation practice in recent years as a result of published data on VTE risk in CS, but also after experience of patients suffering VTEs in the perioperative period.

Conclusions: Despite well recognised incidence and mortality only 48% of surveyed UK Endocrinology centres are routinely advising VTE prophylaxis in CS patients. Clearer guidelines on VTE regimes are needed to help standardise practice. Large multi-centre studies are needed to inform such recommendations on type, timing of initiation and duration of anticoagulation indicated for CS patients.