Intravenous Immunoglobulin (IVIG) in Severe Heparin-Induced Thrombocytopenia (HIT) in a Traumatic Brain Injury (TBI) Patient with Cerebral Venous Sinus Thrombosis (CVST)

By Niall A. Buckley, Mustafa K. Baskaya & Marin E. Darsie
First Online: 30 September 2020

There is an absence of literature discussing heparin-induced thrombocytopenia (HIT) management in traumatic brain injury (TBI) patients with post-traumatic cerebral venous sinus thrombosis (CVST).

Of an estimated 21 to 69 million annual global TBI cases, 29.2% may suffer post-traumatic CVST [1,2,3]. CVST management includes correcting causes, initiating anticoagulation, treating intracranial hypertension, and anticonvulsant prophylaxis [4]. Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are first-line anticoagulation in CVST [5]. HIT occurs more frequently in patients receiving therapeutic compared to prophylactic UFH and with prophylactic dosing of UFH compared to LMWH [6,7,8]. As many as 2.6% of patients receiving prophylactic UFH and 0.2% receiving prophylactic LMWH develop HIT [7, 8]. HIT was also reported in one of 64 TBI patients after the initiation of prophylactic UFH [9].

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