Rivaroxaban Prophylaxis for VTE Prevention in ACTH-Dependent Cushing

Zin Htut; Aastha Mundhra; Katharine Lazarus; Niamh Martin; Debbie Papadopoulou; Karim Meeran; Florian Wernig

doi:10.1530/endoabs.117.P172

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Endocrine Abstracts (2026) 117 P172 | DOI: 10.1530/endoabs.117.P172

SFEBES2026 Poster Presentations Neuroendocrinology and Pituitary (40 abstracts)

Rivaroxaban Prophylaxis for VTE Prevention in ACTH-Dependent Cushing’s Syndrome: Safety and Effectiveness in a Single-Centre Retrospective Cohort

Zin Htut ¹ , Aastha Mundhra ¹ , Katharine Lazarus ¹ , Niamh Martin ^1,2 , Debbie Papadopoulou ² , Karim Meeran ^1,2 & Florian Wernig ^1,2

Author affiliations

¹Imperial College London, London, United Kingdom; ²Imperial College Healthcare NHS Trust, London, United Kingdom

Background: Venous thromboembolism (VTE) risk is substantially elevated in ACTH-dependent Cushing’s syndrome (CS), yet optimal prophylaxis strategies remain undefined. In 2019, our centre introduced oral rivaroxaban 10 mg once daily for patients with ACTH-dependent CS.

Objective: To evaluate whether a protocolised prophylactic rivaroxaban approach is safe and associated with fewer VTE events.

Methods: Single-centre retrospective cohort study of adults with ACTH-dependent CS (pituitary and ectopic) managed from January 2012 to January 2025. Outcomes before protocol adoption (pre-2019; no routine prophylaxis) were compared with those after implementation (post-2019). VTE was confirmed radiologically. Bleeding was classified as major or minor by standard definitions. Haematological indices and adherence were recorded.

Results: Seventy patients were included (29 pre-2019; 41 post-2019) with comparable baseline characteristics; pituitary-dependent Cushing’s disease predominated (26/29 pre-2019; 34/41 post-2019). In the pre-2019 cohort, 4/29 patients (13.7%) experienced six VTE events, occurring both pre-operatively (up to eight months before surgery) and within one month post-operatively. After protocol implementation, 39 patients received rivaroxaban prophylaxis; no new or recurrent VTE occurred. Five patients had prior VTE before endocrine assessment and initiation of rivaroxaban. No major or minor bleeding complications were observed. Haematological parameters remained stable, and all patients completed the prescribed prophylaxis course (median duration: 7.9 months).

Conclusions: This is the first study to evaluate oral rivaroxaban prophylaxis for VTE prevention in ACTH-dependent CS. Compared with a 13.7% VTE rate before 2019, introducing rivaroxaban prophylaxis was associated with complete absence of new or recurrent events and no observed bleeding complications. These findings support early initiation at diagnosis and continuation through the peri- and postoperative period in ACTH-dependent CS.