{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:24:48Z","timestamp":1758637488722},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,7]]},"abstract":"<jats:p content-type=\"fine-print\">U 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.<\/jats:p><jats:p content-type=\"fine-print\">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 \u00d7 10<jats:sup>9<\/jats:sup>\/L on Day 28 compared with 213 \u00d7 10<jats:sup>9<\/jats:sup>\/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 \u00d7 10<jats:sup>9<\/jats:sup>\/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.<\/jats:p>","DOI":"10.3171\/jns.2000.93.1.0136","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:27:38Z","timestamp":1242235658000},"page":"136-139","source":"Crossref","is-referenced-by-count":12,"title":["Heparin-induced thrombocytopenia and thrombosis following subarachnoid hemorrhage"],"prefix":"10.3171","volume":"93","author":[{"given":"Ian F.","family":"Parney","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David E.","family":"Steinke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1056\/NEJM199807093390204","article-title":"Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery.","volume":"339","author":"Agnelli","year":"1998"},{"key":"b2","series-title":"Neurosurgery","first-page":"522","article-title":"Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage.","volume":"41","author":"Anderson","year":"1997"},{"key":"b3","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"27","DOI":"10.3171\/jns.1977.47.1.0027","article-title":"Safety of mini-dose heparin administration for neurosurgical patients.","volume":"47","author":"Barnett","year":"1977"},{"key":"b4","series-title":"Br J Haematol","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1111\/j.1365-2141.1993.tb03072.x","article-title":"Heparin-induced thromobocytopenia and thrombosis: clinical and laboratory studies.","volume":"84","author":"Boshkov","year":"1993"},{"key":"b5","series-title":"Acta Neurochir","first-page":"83","article-title":"Post-operative thromboembolism in neurosurgery. 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