Sunday, May 24, 2009

Hypercoagulable state in Cushing's syndrome: a systematic review.

From http://www.unboundmedicine.com/medline/ebm/record/19454584/full_citation/Hypercoagulable_state_in_Cushing%27s_syndrome:_a_systematic_review_

Author(s) :   van Zaane B, Nur E, Squizzato A, Dekkers OM, Twickler MT, Fliers E, Gerdes VE, Büller HR, Brandjes DP
Institution    Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands; Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Clinical Medicine, University of Insubria, Varese, Italy; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands; Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.


Source:    J Clin Endocrinol Metab 2009 May 19.


Abstract:    CONTEXT: It has been debated whether an increased risk of venous thromboembolism (VTE) exists in patients with Cushing's syndrome (CS).


OBJECTIVE: We aimed to summarize published literature on the effects of endogenous hypercortisolism on coagulation and fibrinolysis, as well as on the clinical outcome of VTE.


DATA SOURCES: We searched the MEDLINE and EMBASE databases up to July 2008. Review of reference lists further identified candidate studies.


STUDY SELECTION: Two investigators independently performed study selection and data extraction. Eligible studies had to include CS patients and either evaluate hemostatic parameters in comparison with control persons or post-treatment levels, or describe the occurrence of VTE.


DATA EXTRACTION: The Newcastle-Ottawa Scale was used to assess study quality. A scoring system divided studies into categories of low, medium and high quality.


DATA SYNTHESIS: Of 441 identified publications, 15 reports were included. They contained information on 8 cross-sectionals, 2 intervention- and 8 cohort studies. No high quality studies were identified. Hypercoagulability was suggested by high levels of factor VIII, IX and von Willebrand factor and evidence of enhanced thrombin generation. A risk of 1.9% and 2.5% was reported for VTE not provoked by surgery, whereas risk of post-operative VTE varied between 0 and 5.6%, with one outlier of 20%. VTE was reported as cause of death in 0-1.9% of CS patients.


CONCLUSIONS: Available studies suggest a high risk of venous thrombosis in patients with Cushing's syndrome. Glucocorticoid-induced hypercoagulability as well as surgery and obesity almost certainly contribute to this thrombotic tendency.


Language    ENG
Pub Type(s)    JOURNAL ARTICLE
PubMed ID    19454584