RISCO TROMBÓTICO ASSOCIADO À TRANSIÇÃO DO ANTICONCEPCIONAL INJETÁVEL PARA O ORAL: UM RELATO DE CASO SOBRE TROMBOSE VENOSA CEREBRAL

Abstract

Introduction: Cerebral venous thrombosis (CVT) is a rare but serious neurological condition caused by obstruction of the cerebral venous sinuses. This condition can lead to increased intracranial pressure and hemorrhagic infarctions. Major risk factors include thrombophilias, infections, pregnancy, and the use of combined hormonal contraceptives, whose estrogenic components promote a prothrombotic state by altering the coagulation cascade and reducing fibrinolytic activity. Case Report: A 23-year-old previously healthy woman presented with severe, refractory headache, accompanied by vomiting and paresthesia in the left upper limb. She reported a recent change in contraceptive method, switching from an injectable (Perfutan) to an oral formulation (Linofeme), without medical supervision. Physical examination revealed paresis in the left upper limb. A non-contrast cranial CT scan showed hyperdensity in the superior sagittal, transverse, and right sigmoid sinuses. CT venography confirmed lack of flow in these sinuses, consistent with CVT. Laboratory tests revealed elevated C-reactive protein and slight coagulation abnormalities. Anticoagulation with enoxaparin was initiated, later switched to rivaroxaban, along with analgesics, antiemetics, and immediate suspension of the contraceptive. The patient showed progressive clinical improvement and partial recanalization on follow-up imaging. Discussion: The management followed current guidelines recommending early anticoagulation with low molecular weight heparin (LMWH), followed by transition to direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). The choice of rivaroxaban is supported by evidence indicating efficacy comparable to warfarin with a lower risk of bleeding. The switch from Perfutan to Linofeme may have triggered the thrombotic event, as the latter contains ethinylestradiol and gestodene, both of which promote a hypercoagulable state. Conclusion: This case highlights the importance of clinical suspicion of CVT in young women with atypical headache using hormonal contraceptives. Early diagnosis and prompt anticoagulation are essential to prevent serious complications.