Cerebral Venous Sinus Thrombosis Due to Low–molecular-weight Heparin-induced Thrombocytopenia

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease that is often the trigger for thrombotic complications. Cerebral venous sinus thrombosis (CVST) represents a small percentage of strokes, frequently proving to be a diagnostic challenge. We report a 31-year-old lady presenting with a persistent headache, 18 weeks after a mild COVID-19 illness. On her second visit, CT venography revealed extensive CVST. She was commenced on low-molecular-weight heparin, and was monitored closely in the neuro-medical intensive care unit. She was discharged 2 weeks later, with no residual neurological deficit, and commenced on a direct oral anticoagulant in the community. CVST should be considered in patients presenting with a refractory headache, with greater suspicion if previously infected with SARS-CoV-2.

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Spontaneous heparin-induced thrombocytopenia presenting as cerebral venous sinus thrombosis

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000805 ◽

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

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Cerebral venous sinus thrombosis associated with spontaneous heparin-induced thrombocytopenia syndrome after total knee arthroplasty

Platelets ◽

10.1080/09537104.2020.1828574 ◽

2020 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Steven R Hwang ◽

Yuxiang Wang ◽

Erika L Weil ◽

Anand Padmanabhan ◽

Theodore E Warkentin ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Heparin Induced Thrombocytopenia ◽

Venous Sinus Thrombosis ◽

Total Knee

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

Interventional Neuroradiology ◽

10.1177/1591019919887821 ◽

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.

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