Cerebral venous and sinus thrombosis complicated by heparin-induced thrombocytopenia

Abstract

Cerebral venous and sinus thrombosis (CVT) is a rare form of venous thromboembolism, with annual incidence of 2–4 per million. Modern imaging techniques, particularly magnetic resonance imaging (MRI) combined with MR-venography and computed tomography venography (CT-v), have greatly improved the diagnosis of CVT. Recently published consensus-based guidelines on the treatment of CVT recommend therapeutic doses of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) for the initial treatment of the disease followed by vitamin K antagonists for secondary CVT prevention. In this paper, we describe the management of patient with acute CVT who developed heparin induced thrombocytopenia thrombosis (HITT) while receiving therapeutic doses of LMWH. This report highlights the importance of careful monitoring of initial treatment with heparin, and discusses the strategy of HITT management in Poland, where most anticoagulants licensed for HITT treatment are virtually not achievable.
Hematologia 2011; 2, 4: 363–369