Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination – A report of two UK cases

Mehta, Puja; Mangion, Sean Apap; Benger, Matthew; Stanton, Biba; Czuprynska, Julia; Arya, Roopen; Sztriha, L.

doi:10.1016/j.bbi.2021.04.006

Cited by 112 publications

(132 citation statements)

References 12 publications

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“…Since the publication of the studies described above, several individual cases of cerebral venous thrombosis or ischemic stroke in close temporal proximity with the administration of the vaccine ChAdOx1 nCov-19 have been published. Most of the cases were accompanied with thrombocytopenia and were described in patients under 60 years of age [17][18][19][20][21][22][23].…”

Section: Vaccine-induced Immune Thrombotic Thrombocytopenia: a Rare New Syndromementioning

confidence: 99%

Adverse rare events to vaccines for COVID-19: From hypersensitivity reactions to thrombosis and thrombocytopenia

Novak

Tordesillas

Cabanillas

2021

International Reviews of Immunology

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vaccines for the prevention of coronavirus disease 2019 started to be developed since the initiation of the COviD-19 pandemic. Up to now, four vaccines have been authorized by international agencies such as european Medicines Agency (eMA). Two are DNA vaccines (ChAdOx1 nCov-19 and Ad26.COv2.S) and two mRNA vaccines (BNT162b2 and mRNA-1273). The administration of the vaccines has been associated with a strong decrease in the infections by SARS-Cov-2 and deaths associated with it. However, in parallel to these results, some rare adverse events have also been described. in that sense, events of thrombosis, thrombocytopenia, and hemorrhage have been described in close temporal proximity to the administration of the DNA vaccines ChAdOx1 nCov-19 and Ad26.COv2.S, but also mRNA vaccines. Recent scientific reports have been released with updated information on the possible association of thrombotic thrombocytopenia and COviD-19 vaccines. On the other hand, since the initiation of the vaccination campaigns, adverse hypersensitivity reactions have been described after mRNA and DNA vaccines administration for COviD-19. Although globally these adverse events are rare, a high proportion of the world population will be exposed to these vaccines. For that reason, their safety and tolerance should be carefully considered. in this review, we provide an updated review of the last scientific findings that can explain the rare side effects that the vaccines for COviD-19 can produce.

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Section: Vaccine-induced Immune Thrombotic Thrombocytopenia: a Rare New Syndromementioning

confidence: 99%

Adverse rare events to vaccines for COVID-19: From hypersensitivity reactions to thrombosis and thrombocytopenia

Novak

Tordesillas

Cabanillas

2021

International Reviews of Immunology

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“…Vaccine-induced immune thrombotic thrombocytopenia is a syndrome that was first reported in April 2021 among patients who had recently received the ChAdOx1 nCoV-19 vaccine. [2][3][4][5][6][7] It closely resembles HIT, in which antibodies, typically immunoglobulin G (IgG), are produced against circulating complexes of PF4 and endogenous heparin. [8][9][10] and regulate hemostasis by releasing PF4, a 70-amino acid protein that binds heparin.…”

Section: Discussionmentioning

confidence: 99%

Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia

Jones

Boisvert

Landry

et al. 2021

CMAJ

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63-year-old man presented to the emergency department with a 5-day history of a cool, painful lef leg, new onset of paresthesia of the lef leg and foot, and severe shortness of breath. The patient had no personal or family history of thrombotic events and no personal history or symptoms of arrythmia. He was a nonsmoker with no symptoms or prior documentation of peripheral vascular, coronary or cerebrovascular disease. He had a history of obesity and hypertension controlled with a single agent. Two rapid point-of-care tests were negative for SARS-CoV-2 earlier on the day of presentation (Abbott ID NOW isothermal nucleic acid test). The patient had received his first dose of the ChAdOx1 nCoV-19 vaccine 20 days before the onset of his symptoms.Upon presentation, we noted that the patient was obese (body mass index 41.8) and hypoxic (oxygen saturation 85% on room air, normal > 90%). His lef foot was cold, pale and insensate, with decreased motor function and absent arterial Doppler signals (Rutherford IIB acute limb ischemia). 1 Laboratory investigations showed thrombocytopenia (platelets 36 [normal 150-400] × 10 9 /L), D-Dimer > 10 000 (normal ≤ 50) ng/mL fibrinogenequivalent units, fibrinogen 1.4 (normal 1.6-4.1) g/L and international normalized ratio 1.3 (normal 0.9-1.1). A computed tomography angiogram showed lef popliteal artery occlusion with no visible tibial vessels, even on delayed imaging. It also showed bilateral segmental pulmonary artery thrombi and thrombus adherent to the wall of the infrarenal aorta (Figure 1).We started therapeutic anticoagulation with intravenous unfractionated heparin. Emergency surgical thrombectomy of the popliteal artery and all tibial arteries yielded a large amount of thrombus. We infused tissue plasminogen activator into the tibial arteries intraoperatively. We obtained good antegrade and retrograde flow, with marked pedal hyperemia and normal triphasic arterial Doppler signals upon reperfusion. Intraoperatively, the patient was intermittently hypoxic, consistent with his substantial pulmonary artery thrombus. KEY POINTS• Vaccine-induced immune thrombotic thrombocytopenia (VITT) must be considered in any patient presenting with thrombosis and thrombocytopenia afer recently receiving a vaccine for SARS-CoV-2 that uses an adenovirus vector (ChAdOx1 nCoV-19 Oxford-AstraZeneca or Ad26.COV2.S Johnson & Johnson-Janssen).

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“…18 There are reported cases of cavernous sinus thrombosis and thrombocytopenia after receiving the ChAdOx1 COVID-19 vaccine. 19 In addition, a recent report details 23 patients who developed a pathogenic PF4-dependent syndrome, unrelated to heparin therapy, after receiving the same vaccine. 20 Prompt recognition of thrombosis and thrombocytopenia in the setting of COVID-19 or recent COVID-19 vaccination, consideration of appropriate workup and initiation of proper management is vital to provide high-quality medical care to these patients.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune heparin-induced thrombocytopenia: a rare manifestation of COVID-19

2021

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We describe the case of a 65-year-old male who presented to an outside hospital for shortness of breath, nausea and vomiting 8 days after testing positive for COVID-19. Initial workup revealed massive bilateral pulmonary emboli and thrombocytopenia. The patient was then admitted to our hospital, received an inferior vena cava filter and initially started on argatroban for autoimmune heparin-induced thrombocytopenia (HIT) prophylaxis. On hospital stay day 6, labs revealed a diagnosis of HIT in the setting of COVID-19. This case highlights the rare occurrence of a patient developing HIT without heparin exposure and in the setting of a novel infectious agent, COVID-19.

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Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination – A report of two UK cases

Cited by 112 publications

References 12 publications

Adverse rare events to vaccines for COVID-19: From hypersensitivity reactions to thrombosis and thrombocytopenia

Adverse rare events to vaccines for COVID-19: From hypersensitivity reactions to thrombosis and thrombocytopenia

Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia

Autoimmune heparin-induced thrombocytopenia: a rare manifestation of COVID-19

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