A patient with Cushing's syndrome may develop a hypercoagulable state.
Changes in the coagulation system associated with excess cortisol:
(1) increase in coagulation factors (fibrinogen, Factor 8, von Willebrand's factor, other)
(2) decrease in fibrinolysis
Manifestations:
(1) deep vein thrombosis
(2) arterial thrombi
The risk of thrombosis increases with risk factors for thrombosis such as immobilization and surgery.
A patient with evidence of hypercoagulability should receive antithrombotic prophylaxis (heparin, LMW heparin) in the perioperative period. This should include procedures such as inferior petrosal sinus sampling.
Therapy with tranexamic acid might be associated with thrombosis.
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