This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Boscaro, M. Articles by Girolami, A. Search for Related Content PubMed PubMed Citation Articles by Boscaro, M. Articles by Girolami, A.

Anticoagulant Prophylaxis Markedly Reduces Thromboembolic Complications in Cushing’s Syndrome

Department of Internal Medicine (M.B.), Division of Endocrinology, University of Ancona, 60100 Ancona, Italy; and Department of Medical and Surgical Sciences, Division of Endocrinology (N.S., A.S., L.B., F.F.), and Second Chair of Medicine (M.T.S., G.M.P., A.G.), University of Padova, 35128 Padova, Italy

Address all correspondence and requests for reprints to: Marco Boscaro, M.D., Department of Internal Medicine, Division of Endocrinology, University of Ancona, 60100 Torrette, Ancona, Italy. E-mail: . m.boscaro{at}ao-umbertoprimo.marche.it

Abstract

A hypercoagulable state and an increased incidence of thromboembolic complications are reported in Cushing’s syndrome. The hypercoagulable state is related to an increase in plasma clotting factors, especially Factor VIII and von Willebrand factor complex, and to an impairment of fibrinolytic capacity. Retrospective analysis of postoperative thromboembolic events in a large group of patients with Cushing’s syndrome, including 75 patients (group 1) evaluated in the period from 1972–1981 not receiving anticoagulants, and 232 patients (group 2), evaluated in the period from 1982–2000. Patients of group 1 underwent routine hemostatic function, i.e. prothrombin time and activated partial thromboplastine time. Patients of group 2 underwent a thorough investigation as to hemostatic parameters and received prophylactic treatment with heparin and/or warfarin. Patients with Cushing’s syndrome showed various abnormalities of hemostatic parameters. A significant correlation between activated partial thromboplastine time and urinary free cortisol was observed. During follow-up, 15 patients (20%; mean follow-up, 9.4 ± 6.4 yr) of group 1 and 14 (6.0%; mean follow-up, 6.6 ± 4.2 yr) of group 2 showed thromboembolic complications. Of these patients, eight of group 1 and one of group 2 died. Survival analysis demonstrated a significantly higher morbidity and mortality due to thromboembolic events in group 1, not receiving anticoagulant prevention, than in group 2, treated with anticoagulants in the perioperative period until cure of the disease and normalization of clotting parameters. Cushing’s syndrome is associated with a hypercoagulable state. An adequate anticoagulant prophylaxis can reverse this prothrombotic state and avoid postoperative thromboembolic events.

This article has been cited by other articles:

				B. Van Zaane, E. Nur, A. Squizzato, O. M. Dekkers, M. B. Twickler, E. Fliers, V. E. A. Gerdes, H. R. Buller, and D. P. M. Brandjes Hypercoagulable State in Cushing's Syndrome: A Systematic Review J. Clin. Endocrinol. Metab., August 1, 2009; 94(8): 2743 - 2750. [Abstract] [Full Text] [PDF]

				J. H. Nguyen, M. B. Lodish, N. J. Patronas, F. Ugrasbul, M. F. Keil, M. D. Roberts, J. Popovic, and C. A. Stratakis Extensive and Largely Reversible Ischemic Cerebral Infarctions in a Prepubertal Child with Hypertension and Cushing Disease J. Clin. Endocrinol. Metab., January 1, 2009; 94(1): 1 - 2. [Full Text] [PDF]

				M. Terzolo, B. Allasino, S. Bosio, E. Brusa, F. Daffara, M. Ventura, E. Aroasio, G. Sacchetto, G. Reimondo, A. Angeli, et al. Hyperhomocysteinemia in Patients with Cushing's Syndrome J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3745 - 3751. [Abstract] [Full Text] [PDF]

				I. Ilias, R. Chang, K. Pacak, E. H. Oldfield, R. Wesley, J. Doppman, and L. K. Nieman Jugular Venous Sampling: An Alternative to Petrosal Sinus Sampling for the Diagnostic Evaluation of Adrenocorticotropic Hormone-Dependent Cushing's Syndrome J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3795 - 3800. [Abstract] [Full Text] [PDF]

				G. Arnaldi, A. Angeli, A. B. Atkinson, X. Bertagna, F. Cavagnini, G. P. Chrousos, G. A. Fava, J. W. Findling, R. C. Gaillard, A. B. Grossman, et al. Diagnosis and Complications of Cushing's Syndrome: A Consensus Statement J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5593 - 5602. [Abstract] [Full Text] [PDF]