Declining mortality of cerebral venous sinus thrombosis with thrombocytopenia after SARS‐CoV‐2 vaccination

Munckhof, Anita van de; Krzywicka, Katarzyna; Sousa, Diana Aguiar de; Kammen, Mayte Sánchez van; Heldner, Mirjam Rachel; Jood, Katarina; Lindgren, Erik; Tatlısumak, Turgut; Putaala, Jukka; Hovinga, Johanna A. Kremer; Levi, Marcel; Arnold, Marcel; Ferro, José M.; Coutinho, Jonathan M.

doi:10.1111/ene.15113

Cited by 42 publications

(36 citation statements)

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“…The presence of intracranial bleeding and a baseline platelet count below 30.000 were identified as independent predictors for mortality (9). Currently, mortality is thought to be declining, which could be explained by the rising knowledge of TTSassociated CVST (8).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

et al. 2021

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We present two cases of ChAdOx1 nCov-19 (AstraZeneca)-associated thrombotic thrombocytopenia syndrome (TTS) and cerebral venous sinus thrombosis (CVST). At the time of emergency room presentation due to persistent headache, blood serum levels revealed reduced platelet counts. Yet, 1 or 4 days after the onset of the symptom, the first MR-angiography provided no evidence of CVST. Follow-up imaging, performed upon headache refractory to nonsteroidal pain medication verified CVST 2–10 days after initial negative MRI. Both the patients received combined treatment with intravenous immunoglobulins and parenteral anticoagulation leading to an increase of platelet concentration in both the individuals and resolution of the occluded cerebral sinus in one patient.

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Section: Discussionmentioning

confidence: 99%

“…The rarity of these findings underlines the distinct type of vaccine-associated CVST. High mortality was described when this phenomenon occurred for the first time in literature ( 8 ). The presence of intracranial bleeding and a baseline platelet count below 30.000 were identified as independent predictors for mortality ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

et al. 2021

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“…Since recognition of this new syndrome, several interim guidelines have been published to help frontline health workers and clinicians [8,11,21,27]. As a result improved identification of VITT and its management have led to a reduction in mortality [28].…”

Section: Discussionmentioning

confidence: 99%

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

Myllylahti

Pitkänen

Magnani³

et al. 2022

Thrombosis J

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Background Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is triggered by nCOV-19 adenovirus-vectored vaccines against SARS-CoV2. Pathogenesis has been mainly related to platelet activation via PF4-reactive antibodies that activate platelets and may cross-react with heparin. Data concerning optimal anticoagulation are anecdotal, and so far, there are scattered reports of danaparoid use in VITT management. Danaparoid has good efficacy and safety in treatment of heparin-induced thrombocytopenia. We report here our experience of the administration and monitoring danaparoid in VITT. Methods We diagnosed a series of six hospitalized cases of VITT, based on the international diagnostic guidance. All VITT-related data were from the local electronic medical and laboratory record system and were analyzed with IBM SPSS Statistics. Results Predominately women in their late 40’s developed VITT on average 24 days (range 9–59) after the first ChAdOx1 dose. Clinical presentation included single or multiple venous and/or arterial thrombosis, moderate thrombocytopenia and high D-dimer levels. After detecting PF4 antibodies subcutaneous danaparoid was our first-line antithrombotic treatment with an average duration of three weeks. 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 [2–18]. One patient died but the other five patients recovered completely. Conclusions The clinical outcomes of our small cohort align with the earlier published reports, and support danaparoid as a rational option for the initial anticoagulation of VITT patients.

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“…Altered mental status or focal neurological deficit may indicate the presence of cerebral ischemia and hemorrhage. One-third of the patients with cerebral venous sinus thrombosis have intracranial hemorrhage at presentation ( 55 ). The presence of abdominal pain at presentation suggests thrombosis of the splanchnic veins.…”

Section: Vaccine-induced Immune Thrombotic Thrombocytopeniamentioning

confidence: 99%

Immune-Mediated Platelet Activation in COVID-19 and Vaccine-Induced Immune Thrombotic Thrombocytopenia

Uzun¹,

Pelzl²,

Singh³

et al. 2022

Front. Immunol.

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Both qualitative and quantitative platelet abnormalities are common in patients with coronavirus disease 2019 (COVID-19) and they correlate with clinical severity and mortality. Activated platelets contribute to the prothrombotic state in COVID-19 patients. Several groups have shown immune-mediated activation of platelets in critically ill COVID-19 patients. Vaccine-induced immune thrombotic thrombocytopenia is an autoimmune condition characterized by thrombocytopenia and life-threatening thrombotic events in the arterial and venous circulation. Although the initial trigger has yet to be determined, activation of platelets by immune complexes through Fc gamma RIIA results in platelet consumption and thrombosis. A better understanding of platelet activation in COVID-19 as well as in vaccine-induced thrombotic complications will have therapeutic implications. In this review, we focused on the role of immune-mediated platelet activation in thrombotic complications during COVID-19 infection and vaccine-induced immune thrombotic thrombocytopenia.

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Declining mortality of cerebral venous sinus thrombosis with thrombocytopenia after SARS‐CoV‐2 vaccination

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 42 publications

References 10 publications

Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

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

Immune-Mediated Platelet Activation in COVID-19 and Vaccine-Induced Immune Thrombotic Thrombocytopenia

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