title: Rotation thromboelastometry and the hypercoagulable state in Cushing's syndrome.
abstract: BACKGROUND
  Rotation thromboelastometry (ROTEM®) can be used for hypercoagulability evaluation. Cushing's syndrome (CS) is associated with hypercoagulability; however, ROTEM® has never been evaluated in this setting.
  
  
  OBJECTIVE
  To evaluate hypercoagulability in CS using ROTEM® and to correlate these parameters with coagulation markers and with the presence of deep vein thrombosis.
  
  
  METHODS
  Thirty patients with active CS (26 women) and 30 controls matched for age, sex, body mass index, diabetes mellitus, arterial hypertension, ABO blood group and smoking were included. We measured levels of activated partial thromboplastin time (aPTT), platelets, fibrinogen, D-dimer, factor VIII (FVIII), von Willebrand factor (vWF) and C-reactive protein. ROTEM® was used to evaluate the intrinsic (INTEM), extrinsic (EXTEM) and fibrinogen (FIBTEM) pathways. Doppler ultrasonography was performed to search for lower limbs deep vein thrombosis.
  
  
  RESULTS
  INTEM clotting time using ROTEM® was shorter in patients than in controls (P = 0·04). Other ROTEM® parameters were not different. Mean aPTT was shorter in patients than in controls (P = 0·001). The FVIII, vWF and D-dimer levels were higher in patients than in controls (P = 0·001, 0·001 and 0·02, respectively). Obese CS patients presented higher levels of platelets and alterations in maximum clot formation (MCF), alpha angle and maximum speed of clot formation of INTEM (P = 0·03, 0·02 and 0·02, respectively) and an increase in the MCF of FIBTEM (P = 0·02). No deep vein thrombosis was found.
  
  
  CONCLUSIONS
  Although FVIII and vWF were abnormal in CS patients, only the initiation clot formation was different in the ROTEM® methodology and no deep vein thrombosis was found.
authors.affiliation: Department of Internal Medicine and Endocrine Unit, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Maria Caroline Alves
authors.initials: MC
authors.lastname: Coelho
authors.forename: Leonardo
authors.initials: L
authors.lastname: Vieira Neto
authors.forename: Leandro
authors.initials: L
authors.lastname: Kasuki
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Wildemberg
authors.forename: Camila Vicente dos
authors.initials: CV
authors.lastname: Santos
authors.forename: Gizele
authors.initials: G
authors.lastname: Castro
authors.forename: Glauber
authors.initials: G
authors.lastname: Gouvêa
authors.forename: Orlando Carlos Gloria
authors.initials: OC
authors.lastname: Veloso
authors.forename: Telma
authors.initials: T
authors.lastname: Gadelha
authors.forename: Mônica R
authors.initials: MR
authors.lastname: Gadelha
mesh_terms: D000328:Adult; D001777:Blood Coagulation; D016022:Case-Control Studies; D003480:Cushing Syndrome / Q000097:blood* / Q000150:complications*; D005260:Female; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012399:Rotation; D013916:Thrombelastography / Q000379:methods*; D019851:Thrombophilia / Q000097:blood* / Q000150:complications*