Early combination treatment of immune thrombocytopenia: Is this the way?

Bussel, James B.

doi:10.1002/ajh.26024

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…Therefore, in patients with CVT with symptom onset within 4 to 42 days of having received a COVID-19 vaccine using adenoviral vectors, following an algorithmic approach to evaluate and treat VITT is advised ( figure 7-2 43,50 ). 43,50,51 …”

Section: Covid-19 and Cerebral Venous Thrombosismentioning

confidence: 99%

“…Fortunately, mortality for patients with VITT-associated CVT has significantly decreased from nearly 50% in March 2021 to around 22% for cases diagnosed thereafter, likely due to the beneficial effect of earlier recognition and improved treatments, especially the avoidance of heparin anticoagulation to treat CVT in VITT 49 . Therefore, in patients with CVT with symptom onset within 4 to 42 days of having received a COVID-19 vaccine using adenoviral vectors, following an algorithmic approach to evaluate and treat VITT is advised ( figure 7-2 43,50 ). 43,50,51 …”

Section: Covid-19 and Cerebral Venous Thrombosismentioning

confidence: 99%

“…As in HIT, therapeutic anticoagulation with nonheparin anticoagulants is the primary treatment for VITT with or without CVT. Based on data from patients with aHIT, administration of IV immunoglobulin (IVIg) as soon as VITT is diagnosed or under consideration is recommended by both the American Society of Hematology (ASH) and the AHA/ASA at a recommend dose of 1 g/kg for two days 50,51 . In patients with severe VITT (extensive thrombosis with platelets <50 × 10 3 /μL) or resistant VITT (continued thrombosis despite medical therapy), treatment with IVIg as a sole immunotherapy might not be enough because of the high antibody burden 43 .…”

Section: Treatmentmentioning

confidence: 99%

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Diagnosis and Treatment of Cerebral Venous Thrombosis

Liberman¹

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVECerebral venous thrombosis (CVT), thrombosis of the dural sinus, cerebral veins, or both, is a rare cerebrovascular disease. Although mortality rates after CVT have declined over time, this condition can result in devastating neurologic outcomes. This article reviews the latest literature regarding CVT epidemiology, details new factors associated with the development of CVT, and describes advances in CVT treatment. It also contains a discussion of future directions in the field, including novel diagnostic imaging modalities, and potential strategies to reduce the risks associated with CVT.LATEST DEVELOPMENTSThe incidence of CVT may be as high as 2 per 100,000 adults per year. It remains a difficult condition to diagnose given its variable clinical manifestations and the necessity of neuroimaging for confirmation. The COVID-19 pandemic has revealed a novel CVT trigger, vaccine-induced immune thrombotic thrombocytopenia (VITT), as well as an association between COVID-19 infection and CVT. Although VITT is a very rare event, timely diagnosis and treatment of CVT due to VITT likely improves patient outcomes. Direct oral anticoagulants are currently being used to treat CVT and emerging data suggest that these agents are as safe and effective as vitamin K antagonists. The role of endovascular therapy to treat CVT, despite a recent clinical trial, remains unproven.ESSENTIAL POINTSThe incidence of CVT has increased, outcomes have improved, and the use of direct oral anticoagulants to treat CVT represents an important advance in the clinical care of these patients. Rates of CVT as a complication of COVID-19 vaccines using adenoviral vectors are very low (<5 per million vaccine doses administered), with the benefits of COVID-19 vaccination far outweighing the risks.

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Section: Covid-19 and Cerebral Venous Thrombosismentioning

confidence: 99%