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January 14, 2020

Spontaneous Heparin-Induced Thrombocytopenia Presenting as Cerebral Venous Sinus Thrombosis

December 2021 issue
11 (6) e929-e931

Abstract

Spontaneous HIT syndrome should be considered in any patient presenting with unexplained thrombocytopenia and unprovoked arterial and/or venous thrombosis, including CVST.

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References

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Greinacher A, Selleng K, Warkentin TE. Autoimmune heparin-induced thrombocytopenia. J Thromb Haemost 2017;15:2099–2114.
2.
Warkentin TE, Basciano PA, Knopman J, Bernstein RA. Spontaneous heparin-induced thrombocytopenia syndrome: 2 new cases and a proposal for defining this disorder. Blood 2014;123:3651–3654.
3.
Warkentin TE, Makris M, Jay RM, Kelton JG. A spontaneous prothrombotic disorder resembling heparin-induced thrombocytopenia. Am J Med 2008;121:632–636.
4.
Okata T, Miyata S, Miyashita F, Maeda T, Toyoda K. Spontaneous heparin-induced thrombocytopenia syndrome without any proximate heparin exposure, infection, or inflammatory condition: atypical clinical features with heparin-dependent platelet activating antibodies. Platelets 2015;26:602–607.
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Greinacher A. Me or not me? The danger of spontaneity. Blood 2014;123:3536–3538.

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 11Number 6December 2021
Pages: e929-e931

Publication History

Received: August 5, 2019
Accepted: November 6, 2019
Published online: January 14, 2020
Published in print: December 2021

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Disclosure

G. Moores reports no disclosures. T.E. Warkentin reports research funding from Instrumentation Laboratory and W.L. Gore and consulting fees from Bayer AG, CSL Behring, Ergomed, Octapharma, W.L. Gore, and for medical-legal testimony. M.A.M. Farooqi reports no disclosures. S.D. Jevtic reports no disclosures. M.P. Zeller reports no disclosures. K.S. Perera reports honoraria from Bayer AG, Abbott, and Servier and research grants from Bayer AG. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Ginette Moores, MD
Departments of Medicine (Neurology) (GM, KSP), Pathology and Molecular Medicine (TEW, MPZ), and Medicine (TEW, MAF, SDJ, MPZ), McMaster University, Hamilton, Ontario, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Theodore E. Warkentin, MD
Departments of Medicine (Neurology) (GM, KSP), Pathology and Molecular Medicine (TEW, MPZ), and Medicine (TEW, MAF, SDJ, MPZ), McMaster University, Hamilton, Ontario, Canada.
Disclosure
Scientific Advisory Boards:
1.
(1) Octapharma
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) Bayer (2) CSL Behring (3) Ergomed (4) W.L. Gore
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Medical-legal consulting/testimony
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
(1) Instrumentation Laboratory (2) W. L. Gore
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Mohammed A.M. Farooqi, MD
Departments of Medicine (Neurology) (GM, KSP), Pathology and Molecular Medicine (TEW, MPZ), and Medicine (TEW, MAF, SDJ, MPZ), McMaster University, Hamilton, Ontario, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Stefan D. Jevtic, HBSc
Departments of Medicine (Neurology) (GM, KSP), Pathology and Molecular Medicine (TEW, MPZ), and Medicine (TEW, MAF, SDJ, MPZ), McMaster University, Hamilton, Ontario, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
(1) McMaster University - Michael G. DeGroote School of Medicine
Research Support, Foundations and Societies:
1.
(1) Alzheimer Society Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Michelle P. Zeller, MD
Departments of Medicine (Neurology) (GM, KSP), Pathology and Molecular Medicine (TEW, MPZ), and Medicine (TEW, MAF, SDJ, MPZ), McMaster University, Hamilton, Ontario, Canada.
Disclosure
Scientific Advisory Boards:
1.
Pfizer advisory board (not relevant to this publication)
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
American Society of Hematology, travel to participate as a question writer for the ASH In-Training Examination Pfizer, travel to Anemia Day in Sept 2018
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Canadian Blood Services, Medical Consultant. Ontario Ministry of Health, Consultant
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Kanjana Sashi Perera, MBBS
Departments of Medicine (Neurology) (GM, KSP), Pathology and Molecular Medicine (TEW, MPZ), and Medicine (TEW, MAF, SDJ, MPZ), McMaster University, Hamilton, Ontario, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Bayer AGAbbott
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Bayer AG for research
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
Hamilton Health Sciences/ Population Health Research Institute
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Perera [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

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Cited By
  1. Investigation of anti-PF4 versus anti-PF4/heparin reactivity using fluid-phase enzyme immunoassay for 4 anti-PF4 disorders: classic heparin-induced thrombocytopenia (HIT), autoimmune HIT, vaccine-induced immune thrombotic thrombocytopenia, and spontaneous HIT, Journal of Thrombosis and Haemostasis, 21, 8, (2268-2276), (2023).https://doi.org/10.1016/j.jtha.2023.04.034
    Crossref
  2. Relationship Between Vaccination and Immune Thrombotic Thrombocytopenia: Coincidental or Causal?, Cureus, (2022).https://doi.org/10.7759/cureus.28560
    Crossref
  3. Acute Ischemic Stroke in the Context of SARS-CoV-2 Vaccination: A Systematic Review, Neuropsychiatric Disease and Treatment, Volume 18, (1907-1916), (2022).https://doi.org/10.2147/NDT.S374549
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  4. Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review, Stroke, 53, 6, (1892-1903), (2022).https://doi.org/10.1161/STROKEAHA.121.036824
    Crossref
  5. COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis, Frontiers in Immunology, 12, (2021).https://doi.org/10.3389/fimmu.2021.729251
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  6. Assessment of systemic inflammatory reactions and coagulopathy against the background of hormonal therapy in covid-associated lung damage, Meditsinskiy sovet = Medical Council, 21, (230-237), (2021).https://doi.org/10.21518/2079-701X-2020-21-230-237
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  7. COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A review of the potential mechanisms and proposed management, Science Progress, 104, 2, (003685042110259), (2021).https://doi.org/10.1177/00368504211025927
    Crossref
  8. Rare case of COVID-19 vaccine-associated intracranial haemorrhage with venous sinus thrombosis, BMJ Case Reports, 14, 9, (e245092), (2021).https://doi.org/10.1136/bcr-2021-245092
    Crossref
  9. The clinical correlates of vaccine-induced immune thrombotic thrombocytopenia after immunisation with adenovirus vector-based SARS-CoV-2 vaccines, Immunotherapy Advances, 1, 1, (2021).https://doi.org/10.1093/immadv/ltab019
    Crossref
  10. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination, New England Journal of Medicine, 384, 22, (2092-2101), (2021).https://doi.org/10.1056/NEJMoa2104840
    Crossref
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