Enoxaparin sodium/romiplostim
- PDF / 170,778 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 5 Downloads / 134 Views
1 S
Enoxaparin sodium/romiplostim Cerebral venous thrombosis, spontaneous epidural and subdural haematoma: case report
A 44-year-old woman developed cerebral venous thrombosis during treatment with romiplostim followed by spontaneous epidural and subdural haematoma on enoxaparin sodium treatment [not all routes stated; durations of treatments to reactions onsets and outcomes not stated] The woman was referred to hospital due to headache, which had started 3 days prior. She had progressive worsening, blurred vision, nausea, vomiting and phonophobia. She also had a painless engorgement of the right cervical area. She had been diagnosed with immune thrombocytopenic purpura (ITP) one year prior. She had initially presented with fatigue and automatic ecchymosis of both inner thighs. After unspecified steroid therapy, her platelet count had improved. Later, she had been admitted multiple times due to bleeding tendency and haemorrhage. She had received treatment with prednisolone [Prezolon], immune globulin [IVIg] and eltrombopag. Initially, she responded, but remitted soon. Two months prior to her referral to the hospital, she had started receiving romiplostim 1 mg/kg once a week for ITP. Her medical history included hypothyroidism, treated with levothyroxine sodium [levothyroxine], and smoking. The neurological examination showed mild weakness of the left arm and leg and a left Babinski sign, without other significant findings. Imaging studies of the cervix and the brain showed thrombosis of the right jugular vein, extending from the ipsilateral subclavian vein to the sigmoid and transverse cerebral sinus, indicating cerebral venous thrombosis secondary to romiplostim. She was admitted to the neurological department. The woman started receiving treatment with therapeutic doses of anticoagulation with SC enoxaparin sodium [enoxaparin] 1 mg/kg twice daily. Her treatment with romiplostim was discontinued. Nine days after the admission, she suddenly developed slurred speech and a rapid decrease of Glasgow coma scale. Brain CT scan showed multiple active bilateral epidural and subdural hematomas, uncal herniation and diffuse brain oedema. She was intubated and was transferred to an ICU. After haematological consultation, her treatment with enoxaparin sodium was discontinued, and she received treatment with unspecified corticosteroids. Decompressive brain surgery was performed as a rescue therapy due to the clinical deterioration. She received platelet and other blood products transfusion before, throughout and after the procedure. She died two days later [cause of death not stated]. Ntantos D, et al. Spontaneous Epidural Hematomas due to Cerebral Venous Thrombosis in a Patient with Immune Thrombocytopenic Purpura. Journal of Stroke and Cerebrovascular Diseases 29: No. 11, Nov 2020. Available from: URL: http://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105244
0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
803502704
Reactions 26 Sep 2020 No. 1823
Data Loading...
