ECE2023 Oral Communications Oral Communications 3: Pituitary and Neuroendocrinology 1 (6 abstracts)
Venous thrombotic events (VTE) across ERCUSYN: details of these VTE’s and do centres anticoagulate on a routine bases?
Kristina Isand 1 , Richard Feelders 2 , Thierry Brue 3 , Miklos Toth 4 , Timo Deutschbein 5 , Martin Reincke 6 , Michal Krsek 7 , Alicia Santos Vives 8 , Frank Demtröder 9 , Olivier Chabre 10 , Christian J. Strasburger 11 , John Wass 12 , Susan M Webb 13 , Ana Aulinas Maso 8 , Vallo Volke 1 & Elena Valassi 13
1University of Tartu, Tartu, Estonia; 2Erasmus Medical Center, Department of Internal Medicine, Rotterdam, Netherlands; 3Aix-Marseille Université, Marseille, France; 4Semmelweis University, Budapest, Hungary; 5Medicover Oldenburg MVZ, Oldenburg, Germany; 6Medizinische Klinik und Poliklinik IV, Campus Innestadt, Munich, Germany; 7First Faculty of Medicine of the Charles University and General University Hospital in Prague, 3rd Department of Medicine, Prague, Czech Republic; 8Hospital & IIB-Sant Pau, Barcelona, Spain; 9KLINIKUM DORTMUND GMBH, Dortmund, Germany; 10CHU Grenoble, GRENOBLE, France; 11Charite Campus Mitte, Berlin, Germany; 12Oxford Univesity Hospitals, Oxford, United Kingdom; 13Hospital de Sant Pau, Barcelona, Spain
For all ERCUSYN investigators
Background: Patients with Cushing’s syndrome (CS) have an increased risk of developing venous thromboembolic complications. There is currently no standard practise for thromboprophylaxis in CS patients.
Aim: To study the details of VTE in patients included in The European Registry on Cushing’s syndrome (ERCUSYN) and study various thromboprophylaxis protocols used among the centres where VTE’s were reported.
Methods: A retrospective observational cohort study; data extraction from the registry was taken on the 07.02.2022. Additional data were requested for all VTE-positive cases and obtained in 93% of cases.
Results: There were 95 VTE among 2173 CS patients (prevalence of 4.4 %). Among the 57 centres included in the database, events were reported in 28. Details on VTE were available for 86 (88.4%) patients. One VTE was diagnosed in 69 patients, two VTE’s in 9, and 3 VTE’s in 6. All together there were 105 VTE. Deep venous thrombosis (DVT) was diagnosed in 50(47,6%) cases, pulmonary embolism (PE) in 29(27,6%) cases, other VTE in 21(20%) cases, and PE/DVT with VTE in uncommon locations or together were diagnosed in 5(4,8%) cases. At the time of the VTE only 30.4% were anticoagulated, on low-molecular-weight heparin (LMWH) (68%), vitamin-K antagonist (VKA) (24%), or on Xa-inhibitor 8%. Following the VTE 93.4% were anticoagulated, the agent used varying widely: 41% received VKA, 34.6% LMWH, 21.8% Xa inhibitor and 2.6% aspirin. The duration of anticoagulation varied from 2 weeks until lifelong (40%). Compression stockings were used in 50.9% of the VTE cases. Looking at the centre’s routine thromboprophylaxis protocols, 43% anticoagulated on a routine basis. 8,3% anticoagulated only pituitary CS, 25% both pituitary and ectopic source CS and 66.7% anticoagulated all CS patients regardless of the aetiology. Anticoagulation schemes varied as far as anticoagulation initiation, the duration of thromboprophylaxis given and agent used; 25.6% anticoagulated preoperatively, 22.2% after confirmation of the diagnosis of CS, 33.3% only in particular situations: high-risk patients, following VTE or if medical therapy for hypercortisolism was started. In 75% of the centres LMWH was used, and less frequently VKA and Xa inhibitors.
Conclusion: We report a high VTE rate in CS patients within ERCUSYN. Most patients were not anticoagulated at the time of the event. There is no uniformly used thromboprophylaxis scheme in centres that reported VTE events. To our knowledge this is the largest registry-based study to date looking at VTE in CS patients.
Volume 90
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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