Successful treatment of thromboses of major arteries after ChAdOx1 nCov-19 vaccination

Goereci, Yasemin; Kleineberg, Nina N.; Madlener, Marie; Neuschmelting, Hannah; Fink, Gereon R.; Warnke, Clemens; Stetefeld, Henning

doi:10.1186/s42466-021-00151-y

Cited by 8 publications

(12 citation statements)

References 8 publications

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“…Two records were excluded because the stroke was due to secondary vaccine-induced immune thrombocytopenia (ITP) and thrombotic thrombocytopenic purpura (TTP), respectively [ 10 , 11 ]. Eighteen articles ( n = 23 patients) [ 3 , 7 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] were included in our review. Baseline demographics, relevant clinical data, stroke characteristics, and outcome of patients described in these studies, including our case, are shown in Tables 1 and 2 .…”

Section: Resultsmentioning

confidence: 99%

Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature

Rizzo

Giussani

Agostoni³

2022

Cerebrovasc Dis

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Introduction: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a prothrombotic syndrome observed after adenoviral vector-based vaccines for severe acute respiratory syndrome coronavirus 2. It is characterized by thrombocytopenia, systemic activation of coagulation, extensive venous thrombosis, and anti-platelet factor 4 antibodies. Arterial thrombosis is less common and mainly affects the aorta, peripheral arteries, heart, and brain. Several cases of ischemic stroke have been reported in VITT, often associated with large vessel occlusion (LVO). Here, we describe a case of ischemic stroke with LVO after Ad26.COV2.S vaccine, then we systematically reviewed the published cases of ischemic stroke and VITT following COVID-19 vaccination. Methods: We describe a 58-year-old woman who developed a thrombotic thrombocytopenia syndrome with extensive splanchnic vein thrombosis and ischemic stroke due to right middle cerebral artery (MCA) occlusion, 13 days after receiving Ad26.COV2.S vaccination. Then, we performed a systematic review of the literature until December 3, 2021 using PubMed and EMBASE databases. The following keywords were used: (“COVID-19 vaccine”) AND (“stroke”), (“COVID-19 vaccine”) AND (“thrombotic thrombocytopenia”). We have selected all cases of ischemic stroke in VITT. Results: Our study included 24 patients. The majority of the patients were females (79.2%) and younger than 60 years of age (median age 45.5 years). Almost all patients (96%) received the first dose of an adenoviral vector-based vaccine. Ischemic stroke was the presenting symptom in 18 patients (75%). Splanchnic venous thrombosis was found in 10 patients, and cerebral venous thrombosis in 5 patients (21%). Most patients (87.5%) had an anterior circulation stroke, mainly involving MCA. Seventeen patients (71%) had an intracranial LVO. We found a high prevalence of large intraluminal thrombi (7 patients) and free-floating thrombus (3 patients) in extracranial vessels, such as the carotid artery, in the absence of underlying atherosclerotic disease. Acute reperfusion therapy was performed in 7 of the 17 patients with LVO (41%). One patient with a normal platelet count underwent intravenous thrombolysis with alteplase, while 6 patients underwent mechanical thrombectomy. A malignant infarct occurred in 9 patients and decompressive hemicraniectomy was performed in 7 patients. Five patients died (21%). Conclusion: Our study points out that, in addition to cerebral venous thrombosis, adenoviral vector-based vaccines also appear to have a cerebral arterial thrombotic risk, and clinicians should be aware that ischemic stroke with LVO, although rare, could represent a clinical presentation of VITT.

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Section: Resultsmentioning

confidence: 99%

Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature

Rizzo

Giussani

Agostoni³

2022

Cerebrovasc Dis

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“…Reports have described carotid artery thrombosis and aortic thrombotic complications [ 187 ], deep vein thrombosis [ 188 , 189 ], myocardial infarction [ 190 ], adrenal infarction/hemorrhage [ 191 , 192 ], and cerebral infarction/intracranial hemorrhage [ 193 ] following adenovirus vector and mRNA vaccinations. Examination to rule out VITT should always be conducted, not only in the case of hemorrhagic events, but also in the case of thrombotic events, due to the concern that a background of VITT may exacerbate the underlying condition with heparin administration.…”

Section: Sars-cov-2 Vaccination-associated Coagulopathymentioning

confidence: 99%

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

Yamada

Asakura

2022

IJMS

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Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.

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“…Thrombus formation after a SARS-CoV-2 vaccination may not only occur in the venous system but also in small or large arteries, including the aorta, carotid arteries, or the iliac arteries. 4 Though thrombophilia was negative, we should be told if the D-dimer values were normal or not. Thrombus formation in SARS-CoV-2 vaccinated may also result from immune thrombocytopenia, why we should know if the thrombocyte counts were ever decreased during the post-vaccination phase.…”

mentioning

confidence: 99%

Impact of SARS-CoV-2 vaccines on the nervous system

Scorza

Finsterer

2022

Clinical Imaging

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Successful treatment of thromboses of major arteries after ChAdOx1 nCov-19 vaccination

Cited by 8 publications

References 8 publications

Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature

Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

Impact of SARS-CoV-2 vaccines on the nervous system

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