HIT in the head: a systematic review of cerebral venous sinus thrombosis in classical and autoimmune heparin-induced thrombocytopenia
Tóm tắt
Heparin-induced thrombocytopenia (HIT) causes thrombosis and thrombocytopenia, usually due to prior heparin exposure, so-called classical HIT. However, in the autoimmune form, the signs and symptoms of HIT occur without prior heparin exposure. Development of cerebral venous sinus thrombosis (CVST) secondary to HIT is a rare occurrence, with relatively few reports in the literature. There is a need to better understand the clinical presentation and treatment paradigms in these rare cases. Therefore, we present the first systematic review of CVST occurring in classical and autoimmune HIT. Cases of HIT-induced CVST were identified through a systematic search of Pubmed from the date of inception to March 2021. Literature search revealed 21 cases of HIT and associated CVST with six cases (28.6%) of autoimmune HIT. Patients presented with signs and symptoms consistent with increased intracranial pressure, intracerebral hemorrhage (ICH), and/or focal neurologic deficits. Headache was the most common symptom with 12 patients (60.0%) presenting as such. 10 patients (47.6%) included in the study developed ICH. Non-heparin anticoagulants, especially direct thrombin inhibitors, were the first-line treatment for the majority of patients (55.6%). Intravenous immunoglobulin (IVIG) was used as treatment for select patients (16.7%) with autoimmune HIT. Few patients received surgical intervention for CVST (14.3%) or ICH (30.0%). Four patients had a full recovery, four patients had residual deficits, and seven patients ultimately expired. Symptoms of HIT-induced CVST are often related to CNS dysfunction. Non-heparin anticoagulants are important to treat CVST, even when patients have concomitant ICH, and may be supplemented with IVIG if treating autoimmune HIT. Rapid identification and treatment of HIT-induced CVST is imperative in order to prevent morbidity and mortality.
Tài liệu tham khảo
Warkentin TE, Kelton JG (2001) Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med 344(17):1286–1292. https://doi.org/10.1056/NEJM200104263441704
Fesler MJ, Creer MH, Richart JM, Edgell R, Havlioglu N, Norfleet G, Cruz-Flores S (2011) Heparin-induced thrombocytopenia and cerebral venous sinus thrombosis: case report and literature review. Neurocrit Care 15(1):161–165. https://doi.org/10.1007/s12028-009-9320-y
Kyritsis AP, Williams EC, Schutta HS (1990) Cerebral venous thrombosis due to heparin-induced thrombocytopenia. Stroke 21(10):1503–1505. https://doi.org/10.1161/01.str.21.10.1503
Meyer-Lindenberg A, Quenzel EM, Bierhoff E, Wolff H, Schindler E, Biniek R (1997) Fatal cerebral venous sinus thrombosis in heparin-induced thrombotic thrombocytopenia. Eur Neurol 37(3):191–192. https://doi.org/10.1159/000117434
Haug V, Linder-Lucht M, Zieger B, Korinthenberg R, Mall V, Mader I (2009) Unilateral venous thalamic infarction in a child mimicking a thalamic tumor. J Child Neurol 24(1):105–109. https://doi.org/10.1177/0883073808321055
Kuitunen A, Sinisalo M, Vahtera A, Hiltunen L, Javela K, Laine O (2018) Autoimmune heparin-induced thrombocytopenia of delayed onset: a clinical challenge. Transfusion 58(12):2757–2760. https://doi.org/10.1111/trf.14814
Gonzales M, Pipalia A, Weil A (2019) Refractory heparin-induced thrombocytopenia with cerebral venous sinus thrombosis treated with IVIg, steroids, and a combination of anticoagulants: a case report. J Invest Med High Impact Case Rep 7:2324709619832324. https://doi.org/10.1177/2324709619832324
Gleichgerrcht E, Lim MY, Turan TN (2017) Cerebral venous sinus thrombosis due to low-molecular-weight heparin-induced thrombocytopenia. Neurologist 22(6):241–244. https://doi.org/10.1097/NRL.0000000000000146
Hwang SR, Wang Y, Weil EL, Padmanabhan A, Warkentin TE, Pruthi RK (2020) Cerebral venous sinus thrombosis associated with spontaneous heparin-induced thrombocytopenia syndrome after total knee arthroplasty. Platelets. https://doi.org/10.1080/09537104.2020.1828574
Okata T, Miyata S, Miyashita F, Maeda T, Toyoda K (2015) Spontaneous heparin-induced thrombocytopenia syndrome without any proximate heparin exposure, infection, or inflammatory condition: atypical clinical features with heparin-dependent platelet activating antibodies. Platelets 26(6):602–607. https://doi.org/10.3109/09537104.2014.979338
Moores G, Warkentin TE, Farooqi MAM, Jevtic SD, Zeller MP, Perera KS (2020) Spontaneous heparin-induced thrombocytopenia presenting as cerebral venous sinus thrombosis. Neurol Clin Pract. https://doi.org/10.1212/cpj.0000000000000805
Warkentin TE, Kelton JG (2001) Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann Intern Med 135(7):502–506. https://doi.org/10.7326/0003-4819-135-7-200110020-00009
Nguyen T-H, Medvedev N, Delcea M, Greinacher A (2017) Anti-platelet factor 4/polyanion antibodies mediate a new mechanism of autoimmunity. Nat Commun 8(1):14945. https://doi.org/10.1038/ncomms14945
Fountas KN, Faircloth LR, Hope T, Grigorian AA (2007) Spontaneous superior sagittal sinus thrombosis secondary to type II heparin-induced thrombocytopenia presenting as an acute subarachnoid hemorrhage. J Clin Neurosci 14(9):890–895. https://doi.org/10.1016/j.jocn.2006.06.011
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535
Ishihara-Kawase K, Ohtsuki T, Sugihara S, Tanaka H, Nakamura T, Kimura A, Matsumoto M (2010) Cerebral sinus thrombosis and heparin-induced thrombocytopenia in a patient with paroxysmal nocturnal hemoglobinuria. Intern Med 49(10):941–943. https://doi.org/10.2169/internalmedicine.49.3053
Lee SK, Willinsky R, Terbrugge K (2002) Dural sinus thrombosis complicated with heparin induced thrombocytopenia and thrombosis (HITT). Interv Neuroradiol 8(1):77–80. https://doi.org/10.1177/159101990200800114
Fukushima Y, Takahashi K, Nakahara I (2020) Successful endovascular therapy for cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia. Interv Neuroradiol 26(3):341–345. https://doi.org/10.1177/1591019919887821
Tsai HC, Yen HC, Hsu JC, Lin CL (2009) Heparin-induced thrombocytopenia associated with intra-tumour haemorrhage in cavernous sinus after cardiac myxoma surgery. Br J Neurosurg 23(1):95–96. https://doi.org/10.1080/02688690802272164
Rice L, Kennedy D, Veach A (1998) Pentosan induced cerebral sagittal sinus thrombosis: a variant of heparin induced thrombocytopenia. J Urol 160(6 Pt 1):2148. https://doi.org/10.1097/00005392-199812010-00056
Barcellona D, Melis M, Floris G, Mameli A, Muroni A, Defazio G, Marongiu F (2020) A “Catastrophic” Heparin-Induced Thrombocytopenia. Case Rep Med 2020:6985020. https://doi.org/10.1155/2020/6985020
Hsieh J, Kuzmanovic I, Vargas MI, Momjian-Mayor I (2013) Cerebral venous thrombosis due to cryptogenic organising pneumopathy with antiphospholipid syndrome worsened by heparin-induced thrombocytopenia. BMJ Case Rep. https://doi.org/10.1136/bcr-2013-009500
Richard S, Perrin J, Lavandier K, Lacour JC, Ducrocq X (2011) Cerebral venous thrombosis due to essential thrombocythemia and worsened by heparin-induced thrombocytopenia and thrombosis. Platelets 22(2):157–159. https://doi.org/10.3109/09537104.2010.527399
Shah SD, Shah C, Vora R (2010) Heparin-induced thrombocytopenia and cerebral venous thrombosis after low-molecular weight heparin. Neurol India 58(4):669–670. https://doi.org/10.4103/0028-3886.68688
Beland B, Busse H, Loick HM, Ostermann H, Van Aken H (1997) Phlegmasia cerulea dolens, cerebral venous thrombosis, and fatal pulmonary embolism due to heparin-induced thrombocytopenic thrombosis syndrome. Anesth Analg 85(6):1272–1274. https://doi.org/10.1097/00000539-199712000-00016
Refaai MA, Warkentin TE, Axelson M, Matevosyan K, Sarode R (2007) Delayed-onset heparin-induced thrombocytopenia, venous thromboembolism, and cerebral venous thrombosis: a consequence of heparin “flushes.” Thromb Haemost 98(5):1139–1140
Pohl C, Harbrecht U, Greinacher A, Theuerkauf I, Biniek R, Hanfland P, Klockgether T (2000) Neurologic complications in immune-mediated heparin-induced thrombocytopenia. Neurology 54(6):1240–1245. https://doi.org/10.1212/wnl.54.6.1240
Buckley NA, Baskaya MK, Darsie ME (2020) Intravenous immunoglobulin (IVIG) in severe heparin-induced thrombocytopenia (HIT) in a traumatic brain injury (TBI) patient with cerebral venous sinus thrombosis (CVST). Neurocrit Care. https://doi.org/10.1007/s12028-020-01101-3
Sun Z, Lan X, Li S, Zhao H, Tang Z, Xi Y (2017) Comparisons of argatroban to lepirudin and bivalirudin in the treatment of heparin-induced thrombocytopenia: a systematic review and meta-analysis. Int J Hematol 106(4):476–483. https://doi.org/10.1007/s12185-017-2271-8
Dulicek P, Ivanova E, Kostal M, Fiedlerova Z, Sadilek P, Hirmerova J (2020) Heparin-induced thrombocytopenia treated with fondaparinux: single center experience. Int Angiol 39(1):76–81. https://doi.org/10.23736/S0392-9590.19.04247-0
Fraielli K, Patel D, Wang D, Sargent K, Gore J (2019) Successful use of fondaparinux in the setting of heparin-induced thrombocytopenia with thrombosis confirmed by serotonin-release assay and Factor V Leiden. J Clin Pharm Ther 44(5):809–812. https://doi.org/10.1111/jcpt.12994