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J Neurol Surg B Skull Base 2024; 85(05): 540-545
DOI: 10.1055/s-0043-1772698
Original Article

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

Alexandra J. White 
1   Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States
2   Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States
,
João Paulo Almeida
2   Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States
,
Jordan C. Petitt
4   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
,
Divya Yogi-Morren
5   Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, United States
,
Pablo F. Recinos 
1   Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States
2   Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Varun R. Kshettry 
1   Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States
2   Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Abstract

Introduction Cushing's disease (CD) is associated with hypercoagulability which is associated with an increased risk of venous thromboembolic events (VTEs) perioperatively. This risk persists even after successful transsphenoidal surgery (TSS). However, there are no current guidelines for pharmacologic thromboprophylaxis in this patient population.

Objective Characterize existing thromboprophylaxis management practices in patients undergoing TSS for CD.

Methods An anonymous RedCap survey comprised of questions about perioperative thromboprophylaxis in CD patients was distributed via the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Tumor Section and the North American Skull Base Society (NASBS) email lists.

Results The survey was distributed to 554 members of the AANS/CNS Joint Tumor Section and 1,094 members of NASBS asking that members who surgically treat CD respond. Sixty responses (3.0% response rate) were received. Fifty-two (86.7%) respondents are involved in the postoperative management of CD patients. Thirty-six (69.2%) treat all patients with postoperative VTE chemoprophylaxis, 8 (15.4%) treat some patients, while 8 (15.4%) do not use chemoprophylaxis. Preferred chemoprophylaxis varies as 26 (59.1%) administer low molecular weight heparin, 14 (31.8%) give unfractionated heparin, 1 (2.3%) give direct oral anticoagulants, and 3 (6.8%) give aspirin. Most (28, 53.8%) of the respondents perceive the VTE risk in this patient population to be 0 to 5%, 16 (30.8%) perceive the risk to be 6 to 10%, and 8 (15.4%) perceive it to be 11 to 20%.

Conclusion There is great variability in VTE detection and postoperative prevention practice patterns in CD patients. This study highlights the need for prospective studies to clarify optimal pharmacologic chemoprophylaxis strategies and duration in this patient population.

Keywords

venous thromboembolic events - chemoprophylaxis - pituitary adenoma - ACTH-secreting - deep vein thrombosis - pulmonary embolism

Supplementary Material



Publication History

Received: 07 April 2023

Accepted: 17 July 2023

Article published online:
29 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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