Introduction: The association between Cushing's syndrome and a hypercoagulable state has been demonstrated in the literature. A standard venous thromboembolism (VTE) prophylaxis regimen has yet to be established, particularly in surgical patients. Here we present outcomes associated with VTE prophylaxis in patients with hypercortisolism undergoing endoscopic transsphenoidal surgery for tumor resection.
Methods: A review of Cushing's syndrome patients undergoing endoscopic transsphenoidal surgery between January 2010 and June 2020 was performed. Administration and type of VTE prophylaxis was recorded, and comparison was made between VTE and hemorrhagic complications before and after institution of a VTE prophylaxis protocol.
Results: A total of 65 patients were identified, 98.5% of which underwent VTE prophylaxis with either 5,000 units of subcutaneous heparin twice daily (n = 44) or 40 mg enoxaparin nightly (n = 20). VTE complications were not significantly different between the subcutaneous heparin and enoxaparin cohorts (4.5 vs. 0%; p = 0.61). The overall incidence of hemorrhagic complications requiring blood transfusion was 1.5%, and there was no significant difference in hemorrhagic complications between heparin and enoxaparin cohorts (0 vs. 5%; p = 0.32).
Conclusion: VTE prophylaxis in addition to sequential compression devices and early ambulation are critical in reducing the incidence of VTE in patients with hypercortisolism. Chemical prophylaxis can be safely instituted in these patients with low risk of hemorrhagic complications.
