Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure
Open Access
- 9 April 2021
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 10 (8), 1599
- https://doi.org/10.3390/jcm10081599
Abstract
Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena.This publication has 38 references indexed in Scilit:
- Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously ThoughtStroke, 2016
- Endovascular treatment of cerebral venous sinus thrombosis (CVST): Is a complete recanalization required for a good clinical outcome?Journal of Neuroradiology, 2016
- Immune thrombocytopenic purpura (ITP) associated with vaccinations: a review of reported casesImmunologic Research, 2014
- The Incidence of Cerebral Venous ThrombosisStroke, 2012
- Trombosis venosa cerebral: aspectos actuales del diagnóstico y tratamientoNeurología, 2011
- Sinus Thrombosis Should Be Treated With AnticoagulationArchives of Neurology, 2008
- The Incidence of Recognized Heparin-Induced Thrombocytopenia in a Large, Tertiary Care Teaching HospitalSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2007
- Thrombophilia and Cerebral Vein ThrombosisPublished by S. Karger AG ,2007
- Intracranial sinus thrombosis in a patient with Crohn disease and factor V Leiden mutation.Archives of Pathology & Laboratory Medicine, 2003
- Acute thrombocytopenic purpura following measles, mumps and rubella vaccination. A report on 23 patientsActa Paediatrica, 1993