Heparin
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Intracranial haemorrhage and lack of efficacy: case report An 85-year-old woman developed intracranial haemorrhage following treatment with heparin for cerebral venous sinus thrombosis (CVST). She also exhibited lack of efficacy following treatment with heparin for CVST. The woman, who had diabetes, glaucoma and cataract, presented with right half paralysis, right convulsion, hemiparesis and sensory disturbance. Upon further evaluation, she was diagnosed with CVST. No apparent intracranial haemorrhage or subarachnoid haemorrhage was observed. She was hospitalised. She started receiving continuous IV infusion of heparin 10000 units/day and levetiracetam. On the third day of this treatment, intracranial haemorrhage was observed around the left precentral and postcentral gyrus. Also, her convulsions recurred. The woman’s levetiracetam dose was increased. An emergency cerebral digital subtraction angiography (DSA) was performed which demonstrated complete occlusion from superior sagittal sinus to confluence, and venous refluxes to the deep venous system and the surface venous system. Venous congestion was located in left parietal lobe. Heparin therapy had no effect on her occluded sinuses. Recanalisation of the occlusion lesion with endovascular treatment was attempted which was not successful. Heparin therapy was continued. On the 5th day, MRI revealed no change in cerebral venous return, complete occlusion of superior sagittal sinus and presence of intracranial haemorrhage. Peripheral oedema was also observed [aetiology not stated]. On the 6th day, her heparin therapy was switched to edoxaban. Thereafter, complete recanalisation of the occluded superior sagittal sinus was noted. Following improvement, she was discharged. Bando T, et al. Clinical Trial Based Rationale for the Successful Use of DOAC in the Treatment of Cerebral Venous Sinus Thrombosis (CVST): A Case Report. Journal of Stroke and Cerebrovascular Diseases 29: No. 11, Nov 2020. Available from: URL: http://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105261 803504959
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Reactions 3 Oct 2020 No. 1824
