Heparin-induced thrombocytopenia and thrombosis following subarachnoid hemorrhage. Case report

Ian F. Parney, David E. Steinke

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


The authors present a case of heparin-induced thrombocytopenia and thrombosis (HITT) that occurred after aneurysmal subarachnoid hemorrhage (SAH), and they review the relevant literature. An immune-mediated syndrome, HITT is characterized by moderate thrombocytopenia and paradoxical vascular thromboses. Although it has been estimated in prospective studies that HITT occurs in between 1 and 3% of patients receiving heparin, it is underrecognized in the neurosurgical literature. In the present case, a 49- year-old woman underwent clipping of a right posterior communicating artery, aneurysm after suffering a Hunt and Hess Grade III SAH. She had an uncomplicated postoperative course with good clip positioning and no vasospasm observed on a cerebral angiogram obtained on Day 7. On Day 23, the patient developed a right hemiparesis and experienced a grand mal seizure. A head computerized tomography scan revealed a hemorrhagic infarct in the left middle cerebral artery distribution. Repeated cerebral angiograms did not show vasospasm. She was thrombocytopenic (platelet count as low as 46 x 109/L on Day 28 compared with 213 x 109/L on Day 1) and had been receiving heparin flushes to maintain intravenous catheter patency. An assay for HITT- associated antibodies was positive. The heparin flushes were discontinued and the platelet count recovered (121 x 109/L). She improved neurologically, but was left with a significant right hemiparesis at discharge. This patient had assay-proven heparin-induced thrombocytopenia despite minimal exposure to heparin. Because there was no evidence of vasospasm or other factors to account for her delayed hemorrhagic infarction, an HITT-related disorder seemed most likely. Despite a large body of literature describing HITT in nonneurosurgical patients, only three previous neurosurgical cases have been published. This case report may serve to heighten awareness of this disorder.

Original languageEnglish (US)
Pages (from-to)136-139
Number of pages4
JournalJournal of neurosurgery
Issue number1
StatePublished - Jul 2000


  • Heparin
  • Subarachnoid hemorrhage
  • Thrombocytopenia
  • Thrombosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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