Pharmacological management of cerebral venous sinus thrombosis with full-dose IV heparin infusion and its clinical outcomes

Abstract OBJECTIVE: To report a case of successful use of unfractionated heparin (UFH) infusion to treat cerebral venous sinus thrombosis (CVST). CASE SUMMARY: A 54-year-old female with a history of ovarian cancer addressed through palliative care, presents to the Emergency Department complaining of...

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Bibliographic Details
Published in:The American journal of emergency medicine 2017-08, Vol.35 (8), p.1208.e1-1208.e3
Main Authors: Fernandez, Andrea, PharmD, Nair, Vidya, PharmD, Mckeone, Anna, MD, FACEP, Ho, Joseph, MD, PhD
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants - therapeutic use
Blood clots
Case reports
Cerebral sinus thrombosis
Comorbidity
Computed tomography
CVST
Dissipation
Drug Administration Schedule
Embolism
Embolisms
Emergency
Emergency medical care
Emergency medical services
Enoxaparin - therapeutic use
Family medical history
Female
Full-dose heparin
Headache
Headaches
Heparin
Heparin - therapeutic use
Humans
Infusions, Intravenous
Middle Aged
Nausea
Ovarian cancer
Patients
Pulmonary Embolism - drug therapy
Sinus
Sinus Thrombosis, Intracranial - diagnosis
Sinus Thrombosis, Intracranial - drug therapy
Sinuses
Stroke
Superior sagittal sinus
Thromboembolism
Thrombosis
Treatment Outcome
Venous Thrombosis - prevention & control
Vomiting
Warfarin
Warfarin - therapeutic use
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Summary:Abstract OBJECTIVE: To report a case of successful use of unfractionated heparin (UFH) infusion to treat cerebral venous sinus thrombosis (CVST). CASE SUMMARY: A 54-year-old female with a history of ovarian cancer addressed through palliative care, presents to the Emergency Department complaining of nausea, vomiting and headache for the last 72 h. The patient was on a home regimen of enoxaparin 1.5 mg/kg subcutaneously daily for recent pulmonary embolism and deep vein thrombosis that developed while on warfarin therapy previously. CT scan showed superior sagittal sinus thrombosis. UFH infusion was initiated and continued for 48 h until the headache dissipated. DISCUSSION: Stable CVST may be treated with UFH infusion; however, there is limited literature that describes UFH dosing for CVST management. CONCLUSIONS: UFH may be considered as one of the pharmacological agents to manage CVST. The dosing for UFH bolus and infusion is similar to treatment dose for pulmonary embolism/deep vein thrombosis management with goal anti-Xa between 0.3 and 0.7 units/mL.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2017.03.041