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Thrombosis in Cushing’s disease; raising the flag of concern

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Abstract

Cushing’s disease (CD) is associated with an increased risk of venous thromboembolic events. The purpose of this review is to discuss preventive strategies for post-operative thrombosis in CD patients and their impact on patient outcomes. A systematic review under PRISMA guidelines was conducted within PubMed, Embase, Web of Science, and Cochrane databases through July 2022. Of the 3207 papers retrieved, seven articles were included in this systematic review. Four hundred forty-eight patients were presented in the reviewed studies and the overall reported mortality was 2.67% (12/448). Three studies utilized prophylaxis methods including graduated compression stockings (GCS) and early ambulation (EA) while the remaining four studies only used anticoagulation medicine. Only 20 patients received pre-operative prophylactic treatment, while 366 patients received post-operative prophylaxis which was delivered either immediately after surgery or at different time intervals within 2 days following the surgery. Thrombotic events mainly occurred within two to 3 months after surgery. Overall, a higher frequency of thromboembolic events and mortality was observed in the control groups in comparison to groups receiving prophylaxis. A combination of anticoagulation, EA, and GCS might reduce thrombotic events and mortality in CD patients after treatment. Although the early commencement of a prophylactic anticoagulation regimen on the same day of surgery and continuing up to 3 months seems beneficial, the application of a prophylactic regimen should be utilized with caution since the number of included studies was insufficient to draw a strong conclusion, as well as neither prospective study nor randomized controlled trials existed.

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Acknowledgements

We are grateful to all those who have helped us to accomplish and fulfil this project.

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Authors and Affiliations

  1. Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran

    Hossein Rabiei

  2. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hossein Rabiei & Ataollah Shahbandi

  3. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Ataollah Shahbandi

  4. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mohammadmahdi Sabahi

  5. Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Mauricio Mandel, Badih Adada & Hamid Borghei-Razavi

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  1. Hossein Rabiei
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Contributions

Hamid Borghei-Razavi and Mohammadmahdi Sabahi have given substantial contributions to the conception or the design of the manuscript, Hossein Rabiei, Ataollah Shahbandi, Mohammadmahdi Sabahi, and Mauricio Mandel to acquisition, analysis, and interpretation of the data. All authors have participated in drafting the manuscript. Badih Adada and Hamid Borghei-Razavi revised it critically. Hamid Borghei-Razavi supervised this project. All authors read and approved the final version of the manuscript. All authors contributed equally to the manuscript and read and approved the final version of the manuscript.

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Correspondence to Hamid Borghei-Razavi.

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Rabiei, H., Shahbandi, A., Sabahi, M. et al. Thrombosis in Cushing’s disease; raising the flag of concern. Neurosurg Rev 46, 32 (2023). https://doi.org/10.1007/s10143-022-01941-x

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  • DOI: https://doi.org/10.1007/s10143-022-01941-x

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