Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin exposure. Cerebral venous sinus thrombosis (CVST) associated with HIT have been rarely reported. To our best knowledge, there is only one reported case of endovascular treatment (EVT) in CVST accompanied by HIT. We want to share a case of treatment failure after EVT for CVST accompanied by HIT.
A 49-year-old woman was admitted with a severe headache. She was diagnosed with CVST. At first, her symptoms got improved with intravenous heparin. After seven days, she gradually complained of severe headaches and right arm weakness. Brain MRI showed focal microbleed in left frontal lobe. The next day, we started by changing to low molecular weighted heparin (LMWH). On the same day, a gradual decrease in platelets was confirmed. Ten days after admission, serum platelet count was confirmed to be 35,000 and LMWH was stopped. She presented severe headache and confusion. Follow-up MRI showed left frontal ICH and engorgedcortical veins. She got emergent mechanical thrombectomy. Huge clot burdens existed in the venous sinus. After thrombectomy, venous drainage almost recovered. One day after EVT, brain CT showed left frontal ICH and gradually increased the amount of ICH in follow-up CT. Despite getting the craniectomy, she was discharged without hope.
The use of anticoagulant is essential in the treatment of CVST. Even in situations where thrombocytopenia and ICH worsen, the use of anticoagulant may not be hesitated. However, it also can elevate the risk of aggravation of ICH. Therefore, it can be a treatment dilemma.