Safety and effectiveness of rivaroxaban thromboprophylaxis in adrenocorticotropic hormone–dependent Cushing syndrome
Authors' conclusion
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.
Study context
- Population
- Adults with adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome (CS) managed 2012–2025; CD the most common subtype39 received rivaroxaban
- Participants
- 70 adults
- Exposure
- Routine rivaroxaban prophylaxis vs no routine prophylaxis
- Post-2019n = 41
- Pre-2019n = 29reference
- Outcome
- VTE incidence
Methodological detailsbefore–after comparison, single-centre
- Before–after comparison
- Single-centre
Main finding
As reported in the abstract
VTE
Pre-2019
13.8%
4 of 29
- Pre-2019: Venous thromboembolism (VTE) events in 4 patients, both pre- and postoperatively
- 6 events
- Post-2019: patients with VTE before endocrine assessment and before rivaroxaban could be initiated
- 5 patients, 7 events
Observational data: associations, not effects.
Further findings
Events
| Outcome | Post-2019 | Pre-2019 |
|---|---|---|
| Cushing disease subtype | 34 | 26 |
- Cushing disease subtype: 26/29 vs 34/41
Safety
- All patients completed the prescribed prophylaxis course (median duration)
- 7.9 months
- No major or minor bleeding complications were observed
- Hematological parameters remained stable
Original publication
Safety and effectiveness of rivaroxaban thromboprophylaxis in adrenocorticotropic hormone–dependent Cushing syndrome. J Clin Endocrinol Metab. Published 16 January 2026. doi:10.
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