Safety and effectiveness of rivaroxaban thromboprophylaxis in ACTH-dependent cushing syndrome
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Context
ACTH-dependent Cushing syndrome (CS) is associated with a markedly increased risk of venous thromboembolism (VTE), yet thromboprophylaxis strategies remain inconsistent across clinical practice. In 2019, our center introduced routine oral
rivaroxaban prophylaxis (10 mg once daily) for all patients with ACTH-dependent CS.
Objective
To evaluate the safety and effectiveness of routine rivaroxaban prophylaxis in ACTH dependent CS.
Methods
We retrospectively reviewed 70 adults with ACTH-dependent CS managed between
2012–2025 (29 pre-2019; 41 post-2019) to compare VTE incidence before and after
the introduction of rivaroxaban.
Results
There were no differences in baseline characteristics between the two groups. Cushing
disease (ie secondary to a pituitary corticotroph adenoma) was the most common
subtype (26/29 pre-2019 and 34/41 post-2019). Among patients without routine prophylaxis (pre-2019), four patients (13.8%) developed six VTE events, occurring
both pre- and postoperatively. In contrast, no new or recurrent VTE events occurred in the post-2019 cohort receiving rivaroxaban prophylaxis (n=39), although five patients had prior VTE before endocrine assessment for hypercortisolism and rivaroxaban initiation. No major or minor bleeding complications were observed. Haematological parameters remained stable, and all patients completed the prescribed prophylaxis
course (median duration: 7.9 months).
Conclusions
In our cohort, VTE incidence was 13.8% without prophylaxis and did not occur after the introduction of routine rivaroxaban. Prophylactic oral rivaroxaban in ACTH-dependent CS was safe and effective in preventing new, recurrent, perioperative, and
postoperative VTE events, supporting its early initiation at diagnosis and continuation through the peri-and postoperative period.
ACTH-dependent Cushing syndrome (CS) is associated with a markedly increased risk of venous thromboembolism (VTE), yet thromboprophylaxis strategies remain inconsistent across clinical practice. In 2019, our center introduced routine oral
rivaroxaban prophylaxis (10 mg once daily) for all patients with ACTH-dependent CS.
Objective
To evaluate the safety and effectiveness of routine rivaroxaban prophylaxis in ACTH dependent CS.
Methods
We retrospectively reviewed 70 adults with ACTH-dependent CS managed between
2012–2025 (29 pre-2019; 41 post-2019) to compare VTE incidence before and after
the introduction of rivaroxaban.
Results
There were no differences in baseline characteristics between the two groups. Cushing
disease (ie secondary to a pituitary corticotroph adenoma) was the most common
subtype (26/29 pre-2019 and 34/41 post-2019). Among patients without routine prophylaxis (pre-2019), four patients (13.8%) developed six VTE events, occurring
both pre- and postoperatively. In contrast, no new or recurrent VTE events occurred in the post-2019 cohort receiving rivaroxaban prophylaxis (n=39), although five patients had prior VTE before endocrine assessment for hypercortisolism and rivaroxaban initiation. No major or minor bleeding complications were observed. Haematological parameters remained stable, and all patients completed the prescribed prophylaxis
course (median duration: 7.9 months).
Conclusions
In our cohort, VTE incidence was 13.8% without prophylaxis and did not occur after the introduction of routine rivaroxaban. Prophylactic oral rivaroxaban in ACTH-dependent CS was safe and effective in preventing new, recurrent, perioperative, and
postoperative VTE events, supporting its early initiation at diagnosis and continuation through the peri-and postoperative period.
Date Issued
2026-02-09
Date Acceptance
2026-01-13
Citation
Journal of Clinical Endocrinology and Metabolism (JCEM), 111 (6), pp.1477-1484
ISSN
0021-972X
Publisher
Oxford University Press
Start Page
1477
End Page
1484
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism (JCEM)
Volume
111
Issue
6
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. See the journal About page for additional terms.
License URL
Identifier
10.1210/clinem/dgag014
Subjects
Cushing syndrome
venous thromboembolism
rivaroxaban
thromboprophylaxis
Publication Status
Published
Date Publish Online
2026-01-16