High prevalence of venous thrombotic events in Cushing's syndrome: data from ERCUSYN and details in relation to surgery

The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in patients included in the European Registry on Cushing's syndrome (ERCUSYN), compare their clinical characteristics with those who did not develop VTE and identify risk factors for VTE. A retrospective observational cohort study. Data extraction from the registry was taken on the 07.02.2022. At the time there were 2174 patients diagnosed with Cushing's syndrome (CS) and 95 VTE's reported in the database. Of 95 VTE events 70 (74%) were in pituitary-dependent CS patients, 12 (12.5%) in adrenal-dependant CS, 10 (10.5%) in ectopic CS and 3 (3%) in CS due to other causes.Sex, UFC value at diagnosis, as well as the number of operations remained statistically significant predictors of VTE.Of patients who were treated with at least one surgery, 12 (13%) VTE occured before and 80 (87%) after the surgery. Nearly half of these VTE's occurred within six months since the operation (36; 45%).Over half the centres who reported VTE did not routinely anticoagulate CS patients. Anticoagulation schemes varied widely. Patients with CS have elevated risk of developing VTE for an extended period of time. From ERCUSYN cohort patients have higher risk for VTE if they need multiple surgeries to treat CS, are males and have high UFC values at the diagnosis of CS.Since there is no agreement on thromboprohpylaxis, a protocol for VTE prevention which is widely adopted appears to be necessary in patients with CS.