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Immune thrombocytopenia — ABIM Board MCQ

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HardHematology/OncologyImmune thrombocytopeniaABIM Board

A 29-year-old woman two weeks postpartum develops headache and a focal seizure. MRI and venography show superior sagittal sinus thrombosis with a small hemorrhagic venous infarct. Platelets and coagulation studies are normal. What is the best acute disease-directed treatment?

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Correct answer: A — Therapeutic low-molecular-weight heparin despite venous hemorrhage

The best answer is “Therapeutic low-molecular-weight heparin despite venous hemorrhage”. Hemorrhagic venous infarction is a consequence of venous outflow obstruction and does not contraindicate therapeutic anticoagulation for CVT. Heparin prevents propagation and facilitates recanalization. Endovascular rescue is reserved for selected deterioration despite medical treatment, not routine initial management.

Reference: AHA Scientific Statement: Diagnosis and Management of Cerebral Venous Thrombosis: https://professional.heart.org/en/science-news/diagnosis-and-management-of-cerebral-venous-thrombosis