Delphi panel consensus on recommendations for thromboprophylaxis of venous thromboembolism in endogenous Cushing's syndrome: a position statement

The objective of this study was to establish recommendations for thromboprophylaxis in patients with endogenous Cushing's syndrome (CS), addressing the elevated risk of venous thromboembolism (VTE) associated with hypercortisolism. A Delphi method was used, consisting of 4 rounds of voting and subsequent discussions. The panel included 18 international experts from 11 countries and 4 continents. Consensus was defined as ≥75% agreement among participants. Recommendations were structured into the following categories: thromboprophylaxis, perioperative management, and VTE treatment. Consensus was reached on several critical areas, resulting in 14 recommendations. Key recommendations include: thromboprophylaxis should be considered at time of CS diagnosis and continued for 3 months after biochemical remission, provided there are no obvious contraindications. The standard weight-based prophylactic dose of low molecular-weight heparin is the preferred agent for thromboprophylaxis in patients with CS. Additionally, perioperatively and around inferior petrosal sinus sampling, thromboprophylaxis should be reconsidered if not already initiated at diagnosis. For VTE treatment, extended thromboprophylaxis is advised continuing for 3 months after Cushing is resolved. These Delphi consensus-based recommendations aim to standardize care practices and enhance patient outcomes in CS by providing guidance on thromboprophylaxis, including its initiation and continuation across various disease states, as well as the preferred agents to use. The panel also highlighted key areas for further research, particularly regarding the use of direct oral anticoagulants in CS and the management of mild CS and mild autonomous cortisol secretion. Additionally, the optimal duration of anticoagulant prophylaxis following curative treatment remains uncertain.

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Publication Details

Journal
European Journal of Endocrinology
Published
2025-02-20
DOI
https://doi.org/10.1093/ejendo/lvaf017
Citations
14
Primary Topic
Venous Thromboembolism Diagnosis and Management
Type
article
Field-Weighted Citation Impact
26.18

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article

Delphi panel consensus on recommendations for thromboprophylaxis of venous thromboembolism in endogenous Cushing's syndrome: a position statement

John Newell‐Price, Sue Pavord, John Wass, Jerome Yves Bertherat et al.
14 citations
European Journal of Endocrinology
Venous Thromboembolism Diagnosis and Management
26.18
article

Delphi panel consensus on recommendations for thromboprophylaxis of venous thromboembolism in endogenous Cushing's syndrome: a position statement

John Newell‐Price, Sue Pavord, John Wass, Jerome Yves Bertherat, Saurabh Sinha, Martín Reincke, Alberto M. Pereira, Richard Abraham Feelders, Elena Valassi, Maria Fleseriu, Mônica R. Gadelha, Frederikus Albertus Klok, Hiroshi Arima, Olaf M. Dekkers, Niki Karavitaki, José Miguel Hinojosa‐Amaya, Kristina Isand, Ann McCormack
article en
14 citations

Abstract

The objective of this study was to establish recommendations for thromboprophylaxis in patients with endogenous Cushing's syndrome (CS), addressing the elevated risk of venous thromboembolism (VTE) associated with hypercortisolism. A Delphi method was used, consisting of 4 rounds of voting and subsequent discussions. The panel included 18 international experts from 11 countries and 4 continents. Consensus was defined as ≥75% agreement among participants. Recommendations were structured into the following categories: thromboprophylaxis, perioperative management, and VTE treatment. Consensus was reached on several critical areas, resulting in 14 recommendations. Key recommendations include: thromboprophylaxis should be considered at time of CS diagnosis and continued for 3 months after biochemical remission, provided there are no obvious contraindications. The standard weight-based prophylactic dose of low molecular-weight heparin is the preferred agent for thromboprophylaxis in patients with CS. Additionally, perioperatively and around inferior petrosal sinus sampling, thromboprophylaxis should be reconsidered if not already initiated at diagnosis. For VTE treatment, extended thromboprophylaxis is advised continuing for 3 months after Cushing is resolved. These Delphi consensus-based recommendations aim to standardize care practices and enhance patient outcomes in CS by providing guidance on thromboprophylaxis, including its initiation and continuation across various disease states, as well as the preferred agents to use. The panel also highlighted key areas for further research, particularly regarding the use of direct oral anticoagulants in CS and the management of mild CS and mild autonomous cortisol secretion. Additionally, the optimal duration of anticoagulant prophylaxis following curative treatment remains uncertain.

European Journal of EndocrinologyVol. 192(3)
Universidade Federal do Rio de Janeiro (BR), University Hospitals Birmingham NHS Foundation Trust (GB), Oregon Health & Science University (US), Universidad Autónoma de Nuevo León (MX), Université Paris Cité (FR), Leiden University Medical Center (NL), Erasmus MC (NL), University Medical Center (US), LMU Klinikum (DE), Universitat Internacional de Catalunya (ES), UNSW Sydney (AU), University of Oxford (GB), NYU Langone Health (US), St Vincent's Hospital Melbourne (AU), Hôpital Cochin (FR), East Tallinn Central Hospital (EE), Assistance Publique – Hôpitaux de Paris (FR), Sheffield Teaching Hospitals NHS Foundation Trust (GB), Centre for Biomedical Network Research on Rare Diseases (ES), Centro de Investigación Biomédica en Red (ES), Oxford Centre for Diabetes, Endocrinology and Metabolism (GB), Hospital Universitário Clementino Fraga Filho (BR), Oxford University Hospitals NHS Trust (GB), Amsterdam University Medical Centers (NL), Neurological Surgery (US), HealthPartners (US), University of Tartu (EE), Nagoya University (JP), University of Birmingham (GB), Ludwig-Maximilians-Universität München (DE), University of Amsterdam (NL), University of Sheffield (GB), Erasmus University Rotterdam (NL)
European Commission
Openalex Percentile: Top 0%
Venous Thromboembolism Diagnosis and Management
26.18
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