Pituitary

, Volume 18, Issue 4, pp 487–493 | Cite as

Perioperative thromboprophylaxis in Cushing’s disease: What we did and what we are doing?

  • Mattia Barbot
  • Viviana Daidone
  • Marialuisa Zilio
  • Nora Albiger
  • Linda Mazzai
  • Maria Teresa Sartori
  • Anna Chiara Frigo
  • Massimo Scanarini
  • Luca Denaro
  • Marco Boscaro
  • Sandra Casonato
  • Filippo Ceccato
  • Carla Scaroni
Article
First Online:

Abstract

Purpose

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.

Keywords

Cushing’s disease Thromboprophylaxis Transsphenoidal surgery Pituitary Thrombosis Fractionated heparin 
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Notes

Acknowledgments

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Conflict of interest

The authors have nothing to disclose.

Ethical standard

The experiment complied with current legislation in our country.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mattia Barbot
    • 1
  • Viviana Daidone
    • 2
  • Marialuisa Zilio
    • 1
  • Nora Albiger
    • 1
  • Linda Mazzai
    • 1
  • Maria Teresa Sartori
    • 2
  • Anna Chiara Frigo
    • 3
  • Massimo Scanarini
    • 4
  • Luca Denaro
    • 4
  • Marco Boscaro
    • 1
  • Sandra Casonato
    • 2
  • Filippo Ceccato
    • 1
  • Carla Scaroni
    • 1
  1. 1.Endocrinology Unit, Department of Medicine DIMEDUniversity of PadovaPaduaItaly
  2. 2.2nd Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular SciencesUniversity HospitalPaduaItaly
  3. 3.Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity HospitalPaduaItaly
  4. 4.Neurosurgical DivisionUniversity HospitalPaduaItaly

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