A rare case of heparin-induced thrombocytopenia and cerebral venous sinus thrombosis with antiphospholipid syndrome and possible systemic lupus erythematosus

Stavropoulos, Ioannis; Liverezas, Anastasios; Papageorgiou, Eleni; Tsiara, S.

doi:10.15557/an.2017.0013

Cited by 3 publications

(3 citation statements)

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“…Mean age was 52 years (SD, 14.6), with 70.4% female prevalence. Concomitant risk factors for CVT were reported in only 2 cases (secondary antiphospholipid antibodies 39 and use of oral contraceptives 37 ). HIT was diagnosed in 20 cases after heparin administration, with heparin subtype including both low molecular weight heparin (n=8, 29.7%) and unfractionated heparin (n=9, 33.3%).…”

Section: Resultsmentioning

confidence: 99%

“…All 20 patients for whom anticoagulant treatment was reported received anticoagulation. Fondaparinux was prescribed in 4 cases (20%), 31,34,38,39 vitamin K antagonists alone in 3 (15%), 42,52,54 and direct thrombin inhibitors in 5 (25%, n=3 argatroban, n=1 bivalirudin, n=1 lepirudin; Table 3). Vitamin K antagonists were prescribed at discharge in all survivors.…”

Section: Features Of Hit-related Cvtmentioning

confidence: 99%

“…While clinical data were available for most of the studies, diagnostics and follow-up data critically varied, with potential ascertainment and reporting bias. On the contrary, most of the studies described thorough coagulation testing, [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] which limits the potential issues deriving from inferred causality (Table S2).…”

Section: Bias Assessment and Study Characteristicsmentioning

confidence: 99%

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Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review

Sousa

Romoli

Kammen³

et al. 2022

Stroke

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Background: Cerebral venous thrombosis (CVT) has recently been reported as a common thrombotic manifestation in association with vaccine-induced thrombotic thrombocytopenia, a syndrome that mimics heparin-induced thrombocytopenia (HIT) and occurs after vaccination with adenovirus-based SARS-CoV-2 vaccines. We aimed to systematically review the incidence, clinical features, and prognosis of CVT occurring in patients with HIT. Methods: The study protocol was registered with PROSPERO (CRD42021249652). MEDLINE, EMBASE and Cochrane CENTRAL were searched up to June 1, 2021 for HIT case series including >20 patients, or any report of HIT-related CVT. Demographic, neuroradiological, clinical, and mortality data were retrieved. Meta-analysis of proportions with random-effect modeling was used to derive rate of CVT in HIT and in-hospital mortality. Pooled estimates were compared with those for CVT without HIT and HIT without CVT, to determine differences in mortality. Results: From 19073 results, we selected 23 case series of HIT (n=1220) and 27 cases of HIT-related CVT (n=27, 71% female). CVT developed in 1.6% of 1220 patients with HIT (95% CI,1.0%–2.5%, I 2 =0%). Hemorrhagic brain lesions occurred in 81.8% of cases of HIT-related CVT and other concomitant thrombosis affecting other vascular territory was reported in 47.8% of cases. In-hospital mortality was 33.3%. HIT-related CVT carried a 29% absolute increase in mortality rate compared with historical CVT controls (33.3% versus 4.3%, P <0.001) and a 17.4% excess mortality compared with HIT without CVT (33.3% versus 15.9%, P =0.046). Conclusions: CVT is a rare thrombotic manifestation in patients with HIT. HIT-related CVT has higher rates of intracerebral hemorrhage and a higher mortality risk, when compared with CVT in historical controls. The recently reported high frequency of CVT in patients with vaccine-induced thrombotic thrombocytopenia was not observed in HIT, suggesting that additional pathophysiological mechanisms besides anti-platelet factor-4 antibodies might be involved in vaccine-induced thrombotic thrombocytopenia-related CVT.

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Section: Resultsmentioning

confidence: 99%

Section: Features Of Hit-related Cvtmentioning

confidence: 99%

Section: Bias Assessment and Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review

Sousa

Romoli

Kammen³

et al. 2022

Stroke

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Cyclosporine-A-Induced Intracranial Thrombotic Complications: Systematic Review and Cases Report

et al. 2021

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This study reported two cases of intracranial thrombotic events of aplastic anemia (AA) under therapy with cyclosporine-A (CsA) and reviewed both drug-induced cerebral venous thrombosis (CVT) and CsA-related thrombotic events systematically. We searched PubMed Central (PMC) and EMBASE up to Sep 2019 for publications on drug-induced CVT and Cs-A-induced thrombotic events. Medical subject headings and Emtree headings were used with the following keywords: “cyclosporine-A” and “cerebral venous thrombosis OR cerebral vein thrombosis” and “stroke OR Brain Ischemia OR Brain Infarction OR cerebral infarction OR intracerebral hemorrhage OR intracranial hemorrhage.” We found that CsA might be a significant risk factor in inducing not only CVT but also cerebral arterial thrombosis in patients with AA.

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A rare case of heparin-induced thrombocytopenia and cerebral venous sinus thrombosis with antiphospholipid syndrome and possible systemic lupus erythematosus

Cited by 3 publications

References 16 publications

Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review

Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review

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Cyclosporine-A-Induced Intracranial Thrombotic Complications: Systematic Review and Cases Report

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