How do I install the Es Cushing Vte Risk Factor Evaluation skill?

Run npx skillmds@latest add dromlakhani/es-cushing-vte-risk-factor-evaluation in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Es Cushing Vte Risk Factor Evaluation safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: docs only. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Es Cushing Vte Risk Factor Evaluation?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Es Cushing Vte Risk Factor Evaluation free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Es Cushing Vte Risk Factor Evaluation?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Es Cushing Vte Risk Factor Evaluation by dromlakhani

Name: Es Cushing Vte Risk Factor Evaluation
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Es Cushing Vte Risk Factor Evaluation

This skill guides evaluation of venous thromboembolism (VTE) risk factors in Cushing's syndrome patients to prevent thrombotic complications. Use when assessing a CS patient for thrombotic risk, especially perioperatively; triggers include preoperative assessment, postoperative period (within 4-6 weeks), or presence of CS with additional risk factors such as prior VTE, immobilization, malignancy, or estrogen use.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Evaluation for Venous Thromboembolism Risk Factors in Cushing's Syndrome

STEP 1 — Gather Information

Collect: surgical status (undergoing/planned surgery, recent surgery <4-6 weeks ago), history of VTE, current immobilization, active malignancy, estrogen use, obesity (BMI>30), known thrombophilias.

STEP 2 — Rule In / Rule Out

First binary fork: Is the patient undergoing surgery or within 4-6 weeks postop OR has prior VTE, current immobilization, active malignancy, or estrogen use?

If yes: Proceed to Step 3 for risk stratification.
If no: Proceed to Step 3 for low-risk classification.

STEP 3 — Classify or Stratify

If perioperative (surgery <4-6 weeks): Classify as Perioperative High Risk. Else if non-perioperative:

Classify as High Risk if prior VTE OR current immobilization OR active malignancy OR estrogen use.
Classify as Low Risk otherwise.

STEP 4 — Decide

If Perioperative High Risk: Recommend perioperative pharmacologic prophylaxis (e.g., LMWH) unless contraindicated. If High Risk (non-perioperative): Consider extended pharmacologic prophylaxis if hospitalized; otherwise, monitor for VTE signs and advise on early ambulation. If Low Risk: Routine clinical monitoring; no specific VTE prophylaxis unless hospitalized for other reasons.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on D-dimer for VTE diagnosis in CS due to frequent false positives from inflammation. Avoid delaying prophylaxis in high-risk surgical CS patients due to bleeding risk concerns without hematology consultation. Remember that CS itself is a prothrombotic state; do not withhold prophylaxis based on normal coagulation studies.

Concrete Clinical Example

A 45-year-old woman with active Cushing's disease (post-transsphenoidal surgery 2 weeks ago) presents for follow-up. She has no prior VTE, is ambulating well, no malignancy, not on estrogen. Step 1: Recent surgery <4-6 weeks ago -> yes. Step 2: Perioperative yes -> proceed to Step 3. Step 3: Classified as Perioperative High Risk. Step 4: Recommend perioperative pharmacologic prophylaxis (e.g., enoxaparin 40 mg daily) until full ambulation.

Source: Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI: 10.1210/jc.2015-1818

---name: es-cushing-vte-risk-factor-evaluationdescription: This skill guides evaluation of venous thromboembolism (VTE) risk factors in Cushing's syndrome patients to prevent thrombotic complications. Use when assessing a CS patient for thrombotic risk, especially perioperatively; triggers include preoperative assessment, postoperative period (within 4-6 weeks), or presence of CS with additional risk factors such as prior VTE, immobilization, malignancy, or estrogen use.---# Evaluation for Venous Thromboembolism Risk Factors in Cushing's Syndrome## STEP 1 — Gather InformationCollect: surgical status (undergoing/planned surgery, recent surgery <4-6 weeks ago), history of VTE, current immobilization, active malignancy, estrogen use, obesity (BMI>30), known thrombophilias.## STEP 2 — Rule In / Rule OutFirst binary fork: Is the patient undergoing surgery or within 4-6 weeks postop OR has prior VTE, current immobilization, active malignancy, or estrogen use?- If yes: Proceed to Step 3 for risk stratification.- If no: Proceed to Step 3 for low-risk classification.## STEP 3 — Classify or StratifyIf perioperative (surgery <4-6 weeks): Classify as Perioperative High Risk.Else if non-perioperative: - Classify as High Risk if prior VTE OR current immobilization OR active malignancy OR estrogen use. - Classify as Low Risk otherwise.## STEP 4 — DecideIf Perioperative High Risk: Recommend perioperative pharmacologic prophylaxis (e.g., LMWH) unless contraindicated.If High Risk (non-perioperative): Consider extended pharmacologic prophylaxis if hospitalized; otherwise, monitor for VTE signs and advise on early ambulation.If Low Risk: Routine clinical monitoring; no specific VTE prophylaxis unless hospitalized for other reasons.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on D-dimer for VTE diagnosis in CS due to frequent false positives from inflammation. Avoid delaying prophylaxis in high-risk surgical CS patients due to bleeding risk concerns without hematology consultation. Remember that CS itself is a prothrombotic state; do not withhold prophylaxis based on normal coagulation studies.## Concrete Clinical ExampleA 45-year-old woman with active Cushing's disease (post-transsphenoidal surgery 2 weeks ago) presents for follow-up. She has no prior VTE, is ambulating well, no malignancy, not on estrogen. Step 1: Recent surgery <4-6 weeks ago -> yes.Step 2: Perioperative yes -> proceed to Step 3.Step 3: Classified as Perioperative High Risk.Step 4: Recommend perioperative pharmacologic prophylaxis (e.g., enoxaparin 40 mg daily) until full ambulation.**Source:** Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI: 10.1210/jc.2015-1818

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