Safety and Effectiveness of Rivaroxaban Thromboprophylaxis in ACTH-Dependent Cushing Syndrome

Background

Adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome is a form of Cushing syndrome caused by excessive ACTH production, most commonly from a pituitary corticotroph adenoma, known as Cushing disease. In this condition, chronically high cortisol levels affect nearly every organ system. One of the most clinically important complications is venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism. Compared with the general population, patients with active Cushing syndrome have a substantially higher risk of clotting, especially around the time of surgery and during the period when cortisol levels remain elevated.

Despite this recognized risk, there has been no universal standard for thromboprophylaxis, or clot-preventive treatment, in ACTH-dependent Cushing syndrome. Practices vary widely between centers and may include low-molecular-weight heparin, aspirin, or no routine prophylaxis at all. This study evaluated whether routine oral rivaroxaban could safely and effectively reduce VTE in this high-risk population.