Low-dose aspirin may be better at preventing thromboses in Cushing’s
US study compared antiplatelet agent to enoxaparin, the current gold standard
Low-dose aspirin, an antiplatelet agent used to reduce blood clotting, may be better than enoxaparin, the current gold standard, at preventing thromboses in people with Cushing’s syndrome, a U.S. study found.
Compared with those on enoxaparin, a form of low-molecular weight heparin (LMWH), patients who took low-dose aspirin had a significantly reduced risk of developing pulmonary embolism (PE), a condition in which a blood clot forms in or travels to the lungs, and deep vein thromboses (DVTs), where clots develop in deep veins, usually in the legs. They also had a lower five-year mortality rate.
“Although LMWH [enoxaparin] is currently recommended as the gold standard for anticoagulation in patients with hypercortisolism [Cushing’s syndrome], our evidence suggests low-dose antiplatelets such as aspirin 81 mg could outperform it. Further research is warranted to confirm and replicate our findings,” the authors wrote.
The study, “Therapeutic Options for the Prevention of Thromboses in Cushing’s Syndrome: A Propensity-Matched, Retrospective Cohort Analysis,” was published in Cureus.
Standardized guideline for anticoagulant use lacking
Cushing’s syndrome refers to a group of disorders marked by prolonged exposure to elevated levels of cortisol, or hypercortisolism. It can be caused either by long-term use of corticosteroid medications or by the body’s own overproduction of cortisol, most often due to a tumor in the brain’s pituitary gland, in which case it is specifically known as Cushing’s disease.
Because cortisol plays a vital role in many bodily functions, chronically high cortisol levels can lead to various physical, hormonal, and psychological symptoms.
Hypercoagulability, or a high tendency for the blood to clot, has been well documented in the context of hypercortisolemia. As a result, people with Cushing’s are at a much higher risk of experiencing thrombotic events, such as PE, DVT in the legs or arms, and superficial venous thrombosis (VT), where clots form in veins close to the skin’s surface.
“Despite this heightened risk for venous thromboembolic events, there appears to be a lack of awareness amongst institutions (and individual practitioners), along with improper management,” the researchers wrote.
There are currently no standardized guidelines for the use of anticoagulants, or blood thinners, to prevent blood clots in people with Cushing’s syndrome, and “while low-molecular-weight heparin (LMWH) is the gold standard, there is little evidence behind this recommendation,” the researchers wrote.
Patients on enoxaparin had higher risk of deep vein thromboses
Here, the researchers retrospectively analyzed the outcomes of 44,673 adults with Cushing’s syndrome from the TriNetX US Collaborative Network, a nationwide healthcare database. They compared those who received enoxaparin, a LMWH sold under the brand name Lovenox, with those treated with other blood thinners, including heparin, warfarin, apixaban, or low-dose aspirin (81 mg).
To ensure comparability, groups were matched for age, sex, race, ethnicity, and health conditions. Patient outcomes were tracked over five years following the start of treatment.
Findings showed no statistically significant differences in the rates of PE, upper or lower extremity DVTs, superficial VTs, bleeding events, transfusion requirements, or all-cause mortality between patients treated with enoxaparin and those receiving other blood thinners.
When compared to aspirin, enoxaparin demonstrated a greater risk for the development of PE, [lower extremity] DVT, and all-cause mortality.
However, when comparing patients on enoxaparin with those on low-dose aspirin, the researchers found those on enoxaparin had a 69.7% higher risk of having PE and a 49.2% higher risk of having lower extremity DVTs. Patients on enoxaparin also had a 27.2% increased risk of all-cause mortality over five years compared with those on low-dose aspirin.
Other outcomes, including upper extremity DVTs, superficial VT, bleeding events, and transfusion rates, showed no statistically significant differences.
To explore whether these findings held true across different forms of Cushing’s syndrome, a subgroup analysis was performed in people with Cushing’s disease. Within this population, enoxaparin continued to be associated with a significantly higher risk of both lower extremity DVTs (67.7%) and all-cause death over five years (59.7%) compared with low-dose aspirin.
“Our study analyzed enoxaparin against warfarin, unfractionated heparin, and apixaban, for which there was no significant risk difference,” the researchers wrote. “When compared to aspirin, enoxaparin demonstrated a greater risk for the development of PE, [lower extremity] DVT, and all-cause mortality. Further prospective trials are required to replicate our findings and confirm the superiority of aspirin over LMWH [enoxaparin].”
About the Author
