Extensive thrombosis after COVID-19 vaccine: cause or coincidence?

Abstract

A 62-year-old Caucasian female patient presented with abdominal pain, vomiting and fever 1 day after administration of COVID-19 vaccine. Bloodwork revealed anaemia and thrombocytosis. Abdominal CT angiography showed a mural thrombus at the emergence of the coeliac trunk, hepatic and splenic arteries, and extensive thrombosis of the superior and inferior mesenteric veins, splenic and portal veins, and the inferior vena cava, extending to the left common iliac vein. The spleen displayed extensive areas of infarction. Aetiological investigation included assessment of congenital coagulation disorders and acquired causes with no relevant findings. Administration of COVID-19 vaccine was considered a possible cause of the extensive multifocal thrombosis. After reviewing relevant literature, it was considered that other causes of this event should be further investigated. Thrombosis associated with COVID-19 vaccine is rare and an aetiological relationship should only be considered in the appropriate context and after investigation of other, more frequent, causes.

Portal Vein Thrombosis Might Develop by COVID-19 Infection or Vaccination: A Systematic Review of Case-Report Studies

“…However, in a 62-year-old woman with PVT that was reported by Graca (mentioned in Table 1 ), the opposite happened. The case was an asthmatic patient with the thrombocytosis of 780 × 10 3 per milliliter ( 45 ). Therefore, still further studies are needed to figure out other underlying mechanisms of the PVT following vaccination and solve this paradox.…”

Portal vein thrombosis as a thrombotic complication of COVID-19 mRNA vaccine: A case report and literature review

“…VITT is a consideration in this setting, however, our patient did not have any worsening of his platelet count during the event as depicted in our table. Graça et al present a similar case but related to the AstraZeneca vaccine [20] . Lack of thrombocytopenia and occurrence of the event within a day after COVID vaccination in both of these cases question whether there are other mechanisms that could play.…”

Portal vein thrombosis after second Pfizer/BioNTech coronavirus disease 2019 vaccine

“…A second patient, a 68-year old female with BMI 30, was found to have isolated portal vein thrombosis after presenting with abdominal pain 14 days after her first dose of the Pfizer/BioNTech BNT162b2 COVID vaccine, and had evidence of antiphospholipid syndrome on workup ( 3 ). The third patient is a 62-year old female with BMI 30 who presented with abdominal pain one day after the first dose of the Oxford/AstraZeneca ChAdOx1-S vaccine and was found to have thrombocytosis, extensive celiac trunk and portomesenteric thrombosis, and no evidence of hypercoagulable disorders ( 4 ). A query of Center for Disease Control and Prevention - Vaccine Adverse Event Reporting System (CDC VAERS) yields 185 reports of portal vein thrombosis (including portosplenomesenteric venous thrombosis) associated with the Pfizer vaccine ( 5 ), but details are not available.…”