ArticleFrontiers in oncology2026
Spinal intradural hematoma after intrathecal drug delivery system implantation in a patient with possible heparin-induced thrombocytopenia: a case report.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intrathecal drug delivery systems (IDDSs) can provide analgesia for selected patients with refractory cancer pain. Neuraxial implantation in patients receiving antithrombotic therapy carries a risk of spinal bleeding. Heparin-induced thrombocytopenia (HIT) is mainly prothrombotic and should be diagnosed by combining clinical probability with laboratory testing. Case presentation: A 50-year-old woman with metastatic rectal adenocarcinoma, refractory cancer pain, previous lower-extremity venous thromboembolism, and chronic aspirin use underwent image-guided IDDS implantation after peri-procedural enoxaparin exposure. Enoxaparin 1.5 mg/kg was stopped 24 hours before implantation. On the same day, she developed acute left lower-extremity weakness (2/5) and blood-tinged cerebrospinal fluid from the intrathecal catheter. Platelets fell from 145 × 10 Conclusion: This case describes spinal intradural hematoma with acute thrombocytopenia after peri-procedural enoxaparin exposure. The findings support possible HIT but do not show that HIT directly caused the hematoma. The event was likely multifactorial. Acute platelet decline after heparin exposure and new neurological deficits after a neuraxial procedure require prompt evaluation and multidisciplinary management.
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