Management of a patient with a rare congenital limb malformation syndrome after SARS‐CoV‐2 vaccine‐induced thrombosis and thrombocytopenia (VITT)

Abstract

A 54‐year‐old man with a rare congenital limb malformation (left image) presented to the Accident and Emergency department with a 7‐day history of worsening headache, bruising and unilateral right calf swelling. There was a strong family history of a rare congenital limb deformity, his mother and his maternal grand‐father having the same congenital deformity. Computed tomography (CT) showed an extensive cerebral venous sinus thrombosis and ultrasonography confirmed a concurrent venous thrombosis in the portal vein (right image, filling defect indicated by arrow).

Experience of danaparoid to treat vaccine-induced immune thrombocytopenia and thrombosis, VITT

“…Intracranial bleeding during CVST has previously proved to be a significant risk factor for detrimental outcome [29], also reported in the largest available VITT cohort [23]. Our results also compare favorably with previously reported use of danaparoid to treat VITT [17][18][19][20].…”

“…Our local guidance for initial anticoagulation during the acute treatment of HIT includes danaparoid, administered either intravenously (loading bolus 1250-3750 U with subsequent tapered infusion till 150-200 U / h) or subcutaneously at doses of 750-1500 U, 2-3 times a day with targeted anti-FXa activity of 0.3-0.5 U / mL [14]. There are a few reports of danaparoid use for treatment of HIT during COVID-19 [15,16] or thrombosis post vaccination [17][18][19][20]. In this study, we want to share our experience of its use to treat VITT.…”

“…The median plasma anti-FXa activity was in the lower part of the therapeutic range and during the first week of danaparoid administration clinical symptoms, platelet counts, and fibrin turnover resolved or significantly improved. The average duration of hospital admission was 10 days [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. One patient died but the other five patients recovered completely.…”

Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review

“… Pfizer-BioNTech mRNA Platelet = 182 × 10 9 /L D-dimer = 24 mg/L Bifurcation of the pulmonary trunk and main pulmonary arteries emboli extending to the lobar segmental and subsegmental branches Rivaroxaban 2 × 15 mg daily for 21 days, followed by rivaroxaban 20 mg daily for a total of 3 months Recovered Muir et al [ 56 ] 48 y/o Male N/A 3 days history of malaise and abdominal pain Ad26.COV2. S vaccine (Johnson & Johnson/Janssen) Platelet = 13,000/mm 3 D-dimer = 117.5 mg/Liter Cerebral venous sinus thrombosis involving the right transverse and straight sinuses and extensive splanchnic vein thrombosis Argatroban & IVIG at a dose of 1 g/kg of ideal body weight Critically ill at the time of the report Sheikh et al [ 57 ] 50 y/o Male N/A Headache, vertigo, and vision changes ChAdOx1 nCoV-19 (AstraZeneca) N/A Central venous sinus thrombosis (CVST) in transverse and sigmoid sinuses Desirudin, IVIG at 1 g/kg/hour and Prednisolone at 1 mg/kg daily Recovered Ramdeny et al [ 58 ] 54 y/o Male Rare congenital limb malformation 7-day history of worsening headache, bruising and unilateral right calf swelling ChAdOx1 nCoV-19 (AstraZeneca) Platelet = 34. x 10 9 /L D-dimer = 6000 ng/mL Extensive cerebral venous sinus thrombosis Therapeutic IVIG and anticoagulation Recovered Bano et al [ 49 ] 53 y/o Female N/A Worsening headache and weakness of the right arm and leg …”

A systemic review and recommendation for an autopsy approach to death followed the COVID 19 vaccination

“… Ⓛ ? Ⓛ 5 AZ UK 32, 25/M 1 st 2 cases CVST, ICB, SAH, thrombocytopenia, death(2) - P(1) Mehta et al [62] NA NA NA NA NA NA NA 6 AZ UK 54/M NS 1 case CVST, VITT, venous thrombosis(1) - P Ramdeny et al [63] NA NA NA NA NA NA NA 7 AZ UK 27/M 1 st 1 case CVST, ICB, thrombocytopenia, death(1) - P Suresh et al [64] NA NA NA NA NA NA NA 8 AZ UK 30/F NS 1 case CVST, venous thrombosis(1) - P Tølbøll Sørensen et al ...…”