Case 129- update 2

Having established the patient has never had Lupus anticoagulant screening before and has no history of VTE you advise doesn’t fulfil criteria for antiphospholipid syndrome. You recommend repeat LA ratio and antibodies in 12 weeks. You explain a LP should be safe given the results and to proceed with Lumbar puncture. You quietly congratulate yourself on swiftly sorting out the coagulation issues and go back to bed for some well earned sleep.

Several days later you receive an on call bleep regarding the same lady. It transpires that the LP was normal and the following day the patient developed new numbness and tingling in her left arm. An MRI Brain was organised and this confirmed the diagnosis of a cerebral saggital sinus thrombosis with associated small intracerebral haemorrhage.

The medical team are concerned about anticoagulation given the small intracerebral haemorrhage. The patient weighs 130kg.

What would you advise regarding anticoagulation for this lady’s cerebral sinus thrombosis?

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