title: Perioperative thromboprophylaxis in Cushing's disease: What we did and what we are doing?
abstract: OBJECTIVE
  Cushing's disease (CD) is associated with an increased risk of thrombotic events, particularly after surgery. No guidelines are available on the management of patients with CD undergoing pituitary transsphenoidal surgery (TSS). We aimed to compare the effectiveness of different prophylactic procedures on the prevention of thrombotic events after surgery in CD.
  
  
  METHODS
  We retrospectively collected data on 78 consecutive patients who underwent TSS for CD between 2001 and 2012 at Padova's Neurosurgical Unit, recording their hemostatic, hormonal and anthropometric parameters. Patients were divided into two groups according to their perioperative management. Group A (34 patients) received fractionated heparin for a maximum of 14 days after surgery. Patients in group B (44 patients) were given no early glucocorticoid replacement therapy, and treated with subcutaneous enoxaparin 4,000-8,000 U/daily (depending on their weight) for 30 days plus graduated elastic stockings until mobilization, and early ambulation.
  
  
  RESULTS
  The whole cohort of patients had clotting and anticoagulant factors significantly higher than the normal range. The two groups were comparable for age, BMI, ACTH, urinary free cortisol levels, outcome of surgery, and main clotting parameters. The surgical procedure did not change during the study period. Three venous thrombotic events [venous thromboembolic events (VTE), 2 associated with pulmonary embolism] were recorded in group A, none in group B (p = 0.079). No hemorrhagic events were reported.
  
  
  CONCLUSIONS
  Provoked thrombotic events pose a major problem in the management of CD patients after surgery, regardless of the procedure's outcome. The prophylactic regimen proposed in this paper afforded an efficacy prophylaxis against postoperative VTE in patients with CD. Due to the rarity of CD, a multicenter study on a larger sample of cases would be warranted in order to collect more thrombotic events.
authors.affiliation: Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 35128, Padua, Italy, mattiabarbot@alice.it.
authors.forename: Mattia
authors.initials: M
authors.lastname: Barbot
authors.forename: Viviana
authors.initials: V
authors.lastname: Daidone
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Zilio
authors.forename: Nora
authors.initials: N
authors.lastname: Albiger
authors.forename: Linda
authors.initials: L
authors.lastname: Mazzai
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sartori
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Massimo
authors.initials: M
authors.lastname: Scanarini
authors.forename: Luca
authors.initials: L
authors.lastname: Denaro
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
authors.forename: Sandra
authors.initials: S
authors.lastname: Casonato
authors.forename: Filippo
authors.initials: F
authors.lastname: Ceccato
authors.forename: Carla
authors.initials: C
authors.lastname: Scaroni
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000097:blood / Q000601:surgery*; D000236:Adenoma / Q000097:blood / Q000601:surgery*; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000990:Antithrombin III / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D004434:Early Ambulation / Q000379:methods; D017984:Enoxaparin / Q000627:therapeutic use*; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D019990:Perioperative Care / Q000379:methods; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000601:surgery*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011486:Protein C / Q000378:metabolism; D017293:Protein S / Q000378:metabolism; D011517:Prothrombin Time; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012189:Retrospective Studies; D053828:Stockings, Compression; D020246:Venous Thrombosis / Q000517:prevention & control*; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; D017293:Protein S; D014841:von Willebrand Factor; D000990:Antithrombin III; D005169:Factor VIII; D006493:Heparin