Intravenous Immunoglobulin (IVIG) in Severe Heparin-Induced Thrombocytopenia (HIT) in a Traumatic Brain Injury (TBI) Patient with Cerebral Venous Sinus Thrombosis (CVST)

2020 ◽  
Author(s):  
Niall A. Buckley ◽  
Mustafa K. Baskaya ◽  
Marin E. Darsie
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intravenous Immunoglobulin ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis

Spontaneous heparin-induced thrombocytopenia presenting as cerebral venous sinus thrombosis

2020 ◽  
pp. 10.1212/CPJ.0000000000000805
Author(s):  
Ginette Moores ◽  
Theodore E. Warkentin ◽  
Mohammed A.M. Farooqi ◽  
Stefan D. Jevtic ◽  
Michelle P. Zeller ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis

scholarly journals Successful endovascular therapy for cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia

2020 ◽  
Vol 26 (3) ◽  
pp. 341-345
Author(s):  
Yoshihisa Fukushima ◽  
Kenji Takahashi ◽  
Ichiro Nakahara
Keyword(s):  
Medical Treatment ◽  
Endovascular Therapy ◽  
Sinus Thrombosis ◽  
Venous Drainage ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Excellent Outcome ◽  
Disturbance Of Consciousness

Introduction Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure. A limited number of studies have reported cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia. Here, we present a case of successful endovascular therapy (EVT) without periprocedural heparinization in this situation. Case presentation A 47-year-old woman taking an oral contraceptive was admitted to our hospital with severe headache to be diagnosed as cerebral venous sinus thrombosis. Initially, she got improved by medical treatment with intravenous unfractionated heparin. However, she rapidly developed disturbance of consciousness and right hemiplegia due to cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia on the 14th hospital day. She underwent emergent EVT by immediate conversion of anticoagulation from heparin to argatroban. Despite a large clot burden, sufficient recanalization and anterograde venous drainage were re-established by combined EVT including aspiration, balloon sinoplasty, and local thrombolysis with urokinase infusion. She got improved immediately after the intervention and discharged home without any neurological sequelae after two months. Conclusion This unique case of cerebral venous sinus thrombosis worsened by occurrence of heparin-induced thrombocytopenia during the treatment finally resulted in excellent outcome highlights effectiveness of emergent endovascular intervention for critical cerebral venous sinus thrombosis resistant to initial medical treatment and of immediate establishment of effective anticoagulant strategy for both of heparin-induced thrombocytopenia and cerebral venous sinus thrombosis. Neuroendovascular therapy for cerebral venous sinus thrombosis using alternative argatroban to heparin for periprocedural anticoagulation might be safe and feasible.

Venous sinus thrombosis in traumatic brain injury: a major trauma centre experience

2021 ◽  
Author(s):  
Lauren Harris ◽  
Dominic Townsend ◽  
Rose Ingleton ◽  
Alice Kershberg ◽  
Chris Uff ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Major Trauma ◽  
Sinus Thrombosis ◽  
Trauma Centre ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Major Trauma Centre

Delayed-Onset Heparin-Induced Thrombocytopenia With Cerebral Venous Sinus Thrombosis Following Total Knee Arthroplasty: Case Report

2021 ◽  
pp. 194187442110429
Author(s):  
Megan M. J. Bauman ◽  
Ryan M. Naylor ◽  
Ashley R. Santilli ◽  
Eelco F. Wijdicks
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Delayed Onset ◽  
Total Knee

Heparin-induced thrombocytopenia (HIT) is a prothrombotic state caused by autoantibodies against platelet factor 4 (PF4)-heparin complexes. Although HIT typically presents 5-10 days after the initiation of heparin, thrombosis and thrombocytopenia may occur up to several weeks following heparin withdrawal, so-called delayed-onset HIT. Although rare, there have been isolated reports of HIT-induced cerebral venous sinus thrombosis (CVST), which carry high rates of morbidity and mortality. There is a need to further characterize the etiology, clinical presentation, treatment paradigms, and outcomes of patients with HIT-induced CVST. Here, we present the case of a 57-year old female who presented to the emergency department with a headache and seizure 11 days following a right total knee arthroplasty for which she received 3 post-operative doses of enoxaparin. Work-up demonstrated acute intracerebral hemorrhage (ICH), CVST, and thrombocytopenia. Intravenous heparin resulted in rapidly deteriorating platelet count and subsequent serologic testing confirmed the diagnosis of HIT. Treatment with bivalirudin was initiated, the HIT resolved, and the patient was discharged home on hospital day 19 with long-term anticoagulation mediated by warfarin. At 3-month follow up, the patient had mild upper motor neuron pattern weakness and was living independently. This case depicts a rare case of delayed-onset HIT and CVST, highlights the importance of establishing a fluid treatment plan for managing HIT-induced CVST, and illustrates the importance of employing rapid anticoagulation despite acute ICH to achieve a desirable clinical outcome.

scholarly journals Trombose, Hemorragia e Trombocitopenia Induzidas pelas Vacinas contra a COVID-19: Protocolo de Atuação

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Sara Morais ◽  
Eugénia Cruz
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Diagnosis And Treatment ◽  
Current Evidence ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Unusual Combination

After widespread vaccination with COVID-19 vaccines, there have been worldwide reports on thrombosis, bleeding, and thrombocytopenia. Recently, a rare syndrome with a high mortality rate consisting of an unusual combination of thrombocytopenia and thrombosis, in particular cerebral venous sinus thrombosis, which clinically resembles heparin-induced thrombocytopenia, was reported following vaccination. Different statements and recommendations were developed regarding the definition, diagnosis, and treatment of these rare complications. We present here a protocol with recommendations, based on current evidence.

Heparin-Induced Thrombocytopenia and Cerebral Venous Sinus Thrombosis: Case Report and Literature Review

2010 ◽  
Vol 15 (1) ◽  
pp. 161-165 ◽  
Author(s):  
Mark J. Fesler ◽  
Michael H. Creer ◽  
John M. Richart ◽  
Randall Edgell ◽  
Necat Havlioglu ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis

scholarly journals Refractory Heparin-Induced Thrombocytopenia With Cerebral Venous Sinus Thrombosis Treated With IVIg, Steroids, and a Combination of Anticoagulants: A Case Report

2019 ◽  
Vol 7 ◽  
pp. 232470961983232 ◽  
Author(s):  
Mia Gonzales ◽  
Amrish Pipalia ◽  
Andrew Weil
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Small Subset ◽  
Severe Thrombocytopenia ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Increased Risk ◽  
Risk For Thrombosis

Heparin-induced thrombocytopenia (HIT) type II is caused by antibody production that bind complexes between heparin and platelet factor 4 leading to platelet consumption and thrombosis. In a small subset of cases referred to as autoimmune HIT, the antibodies activate platelets even in the absence of heparin. Refractory HIT is a type of autoimmune HIT in which thrombocytopenia persists for weeks after heparin discontinuation and carries increased risk for thrombosis and more severe thrombocytopenia. We present a case of refractory HIT with cerebral venous sinus thrombosis (CVST) that was successfully treated with a change in anticoagulant alongside steroids and a second trial of intravenous immunoglobulin (IVIg).

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