Anticoagulation in haemorrhagic cerebral venous thrombosis with post-partum cardiomyopathy: Case Report

Introduction: Cerebral venous thrombosis (CVT) is one type of uncommon stroke. The postpartum period is a risk factor for CVT. Cardiomyopathy increases the risk of CVT because of prothrombotic state. CVT may be accompanied with haemorrhage. We reported a haemorrhage CVT with favourably responded with anticoagulant.Case Presentation: We reported a 29-year-old Female, with acute onset headache, tingling, and left-sided weakness. She had a history of preeclampsia, postpartum cardiomyopathy, and mitral regurgitation. On non-contrast head CT scan revealed right occipital subdural haemorrhage. During hospitalization, the neurological deficit worsened with new-onset seizures. Non-contrast head MRI MRA revealed occipital subacute hematoma and loss of right cerebral vein topography. The patient was treated with low-dose unfractionated heparin (UFH). After 5 days of anticoagulation, the neurological deficit improved with no bleeding complication.Discussion: Anticoagulant therapy is still recommended despite haemorrhage features in CVT. The choice of CVT therapy recommendations in cases of pregnancy and puerperium is not different. We use UFH because of the readiness of protamine sulphate as antidote and short-acting feature so that we may control the bleeding complication.Conclusion: CVT may accompanied with haemorrhage. Anticoagulation remains the first-line treatment in CVT. We suggest clinicians to treat CVT with anticoagulant despite the presence of haemorrhage while considering the benefits and risks of the anticoagulant