PMID- 34089462
OWN - NLM
STAT- MEDLINE
DCOM- 20220112
LR  - 20220112
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 52
IP  - 3
DP  - 2021 Oct
TI  - HIT in the head: a systematic review of cerebral venous sinus thrombosis in 
      classical and autoimmune heparin-induced thrombocytopenia.
PG  - 952-961
LID - 10.1007/s11239-021-02484-6 [doi]
AB  - 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.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer Science+Business 
      Media, LLC, part of Springer Nature.
FAU - Bauman, Megan M J
AU  - Bauman MMJ
AUID- ORCID: 0000-0003-1910-6617
AD  - Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
AD  - Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
FAU - Naylor, Ryan M
AU  - Naylor RM
AD  - Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
FAU - Wijdicks, Eelco F
AU  - Wijdicks EF
AD  - Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. 
      wijde@mayo.edu.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20210605
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - Heparin/adverse effects
MH  - Humans
MH  - Immunoglobulins, Intravenous
MH  - *Sinus Thrombosis, Intracranial/chemically induced/drug therapy
MH  - *Thrombocytopenia/chemically induced/drug therapy
OTO - NOTNLM
OT  - Cerebral venous sinus thrombosis
OT  - Heparin-induced thrombocytopenia
OT  - Intracranial hemorrhage
OT  - Neurocritical care
OT  - Stroke
EDAT- 2021/06/06 06:00
MHDA- 2022/01/13 06:00
CRDT- 2021/06/05 12:10
PHST- 2021/05/18 00:00 [accepted]
PHST- 2021/06/06 06:00 [pubmed]
PHST- 2022/01/13 06:00 [medline]
PHST- 2021/06/05 12:10 [entrez]
AID - 10.1007/s11239-021-02484-6 [pii]
AID - 10.1007/s11239-021-02484-6 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2021 Oct;52(3):952-961. doi: 10.1007/s11239-021-02484-6. 
      Epub 2021 Jun 5.