Fondaparinux to treat cerebral venous sinus thrombosis complicated by heparin-induced thrombocytopenia during puerperium: A case report and literature review

BACKGROUND: Cerebral venous sinus thrombosis (CVST) occurring during the puerperium is a rare yet life-threatening condition. The management of CVST becomes more complex when complicated by heparin-induced thrombocytopenia (HIT), a prothrombotic adverse effect of heparin therapy. CASE PRESENTATION: A case of puerperium-associated CVST with HIT is presented, in which fondaparinux was utilized as an alternative anticoagulant during the acute phase, followed by rivaroxaban. A multidisciplinary approach was employed, which included hematoma drainage, decompressive craniectomy, and endovascular recanalization. The patient achieved a favorable outcome, with a modified Rankin scale score of 2 at the 3-month follow-up. CONCLUSION: This case highlights the potential safety and efficacy of fondaparinux in the management of CVST with HIT, emphasizing the critical role of a multidisciplinary approach in optimizing patient recovery.