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. 2025 Mar 3;192(3):R17-R27.
doi: 10.1093/ejendo/lvaf017.

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

Kristina Isand  1   2   3 , Hiroshi Arima  4 , Jerome Bertherat  5 , Olaf M Dekkers  6   7 , Richard A Feelders  8   9 , Maria Fleseriu  10   11 , Monica R Gadelha  12 , Jose Miguel Hinojosa-Amaya  13 , Niki Karavitaki  14   15   16 , Frederikus A Klok  17 , Ann McCormack  18 , John Newell-Price  19 , Sue Pavord  20 , Martin Reincke  21 , Saurabh Sinha  22 , Elena Valassi  23   24   25 , John Wass  2 , Alberto M Pereira Arias  26
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Free article

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

Kristina Isand et al. Eur J Endocrinol. .
Free article

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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.

Keywords: ACTH; Cushing's syndrome; cortisol; low molecular–weight heparin; perioperative; pituitary; position statement; remission; thromboprophylaxis; venous thromboembolism.

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Conflict of interest statement

Conflict of interest: (1) M.F. has been a PI with research funding to the University from Crinetics and Sparrow and has received occasional scientific consulting fees from Crinetics, Recordati, Sparrow, and Xeris. (2) M.R.G. has received speaker fees from Recordati and attended advisory boards for Recordati. (3) M.R. has received speaker and consulting fees from Crinetics, Recordati, HRA Pharma, and Damian. (4) J.N.-P. has had consultancy fees paid to his University from Crinetics, Recordati, HRA Pharma, and Diurnal. (5) N.K. has received speaker for Pfzer, HRA Pharma, Recordati Rare Diseases—investigator for HRA Pharma—Scientific Advisory Board for Pfizer, and Recordati Rare Diseases. (6) A.M. has received speaker and advisory board consulting fees from Recordati and Novo Nordisk.

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