Cerebral venous thrombosis and thrombocytopenia post-COVID-19 vaccination

Franchini, Massimo; Testa, Sophie; Pezzo, Mario; Glingani, Claudia; Caruso, Beatrice; Terenziani, Isabella; Pognani, Claudio; Bellometti, Simona; Castelli, Gianpaolo

doi:10.1016/j.thromres.2021.04.001

Cited by 38 publications

(42 citation statements)

References 4 publications

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“…To date, 40 cases of VITT have been published 34‐37 and their main characteristics are summarized in Table 1. Sixty‐seven percent (27/40) of patients were females with a female/male ratio of 2.1.…”

Section: Clinical and Diagnostic Aspectsmentioning

confidence: 99%

COVID‐19 vaccine‐associated immune thrombosis and thrombocytopenia (VITT): Diagnostic and therapeutic recommendations for a new syndrome

Franchini

Liumbruno

Pezzo

2021

European J of Haematology

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122

106

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Very rare cases of thrombosis associated with thrombocytopenia have occurred following the vaccination with AstraZeneca COVID‐19 vaccine. The aim of this concise review is to summarize the current knowledge on the epidemiologic and pathogenic mechanisms of this syndrome named vaccine‐associated immune thrombosis and thrombocytopenia (VITT). A practical patient management section will also be dealt with using information available from national and international scientific societies as well as expert panels. A literature search on the VITT syndrome was carried out in PubMed using appropriate MeSH headings. Overall, 40 VITT cases have been reported. Continuous pharmacovigilance monitoring is needed to collect more data on the real incidence and the pathogenesis of VITT syndrome. Such information will also help us to optimize the management this rare but often clinically severe thrombotic condition associated with COVID‐19 vaccination.

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Section: Clinical and Diagnostic Aspectsmentioning

confidence: 99%

COVID‐19 vaccine‐associated immune thrombosis and thrombocytopenia (VITT): Diagnostic and therapeutic recommendations for a new syndrome

Franchini

Liumbruno

Pezzo

2021

European J of Haematology

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122

106

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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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“… 1 , 2 An immune mechanism of thrombotic events following vaccination with ChAdOx1 nCoV-19 was proposed, with the identification of anti-PF4 antibodies without previous heparin exposure. 3 Most of the patients with cerebral thrombotic events and thrombocytopenia presented with cerebral venous thrombosis, 4 to our knowledge there are eleven cases of patients who suffered an acute ischemic stroke reported. 3 , 5 , 6 , 7 , 8 , 9 Vaccine related arterial thrombosis in the brain is exceedingly rare but potentially a life-threatening situation and the best choice of treatment is yet to be established.…”

Section: Background and Purposementioning

confidence: 99%

Treatment of ChAdOx1 nCoV-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia Related Acute Ischemic Stroke

Kenda

Lovrič

Škerget

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Recently cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) and thrombosis following the adenoviral vector vaccine against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported. A mechanism similar to heparin-induced thrombocytopenia was proposed with antibodies to platelet factor 4 (PF4). Vaccine related arterial thrombosis in the brain is rare but life-threatening and optimal treatment is not established. We report clinical, laboratory, imaging findings and treatment in a 51-year-old female presenting with acute left middle cerebral artery (MCA) occlusion 7 days after the first dose of ChAdOx1 nCoV-19 vaccine. Due to low platelet count and suspicion of VITT she was not eligible for intravenous thrombolysis (IVT) and proceeded to mechanical thrombectomy (MER) with successful recanalization four hours after onset of symptoms. Treatment with intravenous immunoglobulin (IVIG) and heparin pentasaccharide fondaparinux was initiated. Presence of anti-PF4 antibodies was confirmed. The patient improved clinically with normalization of platelet count. Clinicians should be alert of VITT in patients with acute ischemic stroke after ChAdOx1 nCov-19 vaccination and low platelet counts. MER showed to be feasible and effective. We propose considering MER in patients with VITT and large vessel occlusion despite thrombocytopenia. High-dose IVIG should be started immediately. Alternative anticoagulation to heparin should be started 24 hours after stroke onset unless significant hemorrhagic transformation occurred. Platelet transfusion is contraindicated and should be considered only in severe hemorrhagic complications. Restenosis or reocclusion of the revascularized artery is possible due to the hypercoagulable state in VITT and angiographic surveillance after the procedure is reasonable.

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Cerebral venous thrombosis and thrombocytopenia post-COVID-19 vaccination

Cited by 38 publications

References 4 publications

COVID‐19 vaccine‐associated immune thrombosis and thrombocytopenia (VITT): Diagnostic and therapeutic recommendations for a new syndrome

COVID‐19 vaccine‐associated immune thrombosis and thrombocytopenia (VITT): Diagnostic and therapeutic recommendations for a new syndrome

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

Treatment of ChAdOx1 nCoV-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia Related Acute Ischemic Stroke

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