Thrombocytopenia in Virus Infections

Raadsen, Matthijs P.; Toit, Justin Du; Langerak, Thomas; Bussel, Bas C.T. van; Gorp, Eric C. M. Van; Goeijenbier, Marco

doi:10.3390/jcm10040877

Cited by 78 publications

(69 citation statements)

References 251 publications

(170 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…"COVID-19 vaccine AstraZeneca" uses as a vector the modified, non-replicant chimpanzee adenovirus ChAdOx1. Thrombocytopenia has been reported in the context of adenovirus replication [18].…”

Section: Thrombocytopenia and Thromboembolic Complicationsmentioning

confidence: 99%

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

Wolf

Luz

Niehaus

et al. 2021

JCM

140

154

View full text Add to dashboard Cite

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.

show abstract

Section: Thrombocytopenia and Thromboembolic Complicationsmentioning

confidence: 99%

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

Wolf

Luz

Niehaus

et al. 2021

JCM

140

154

View full text Add to dashboard Cite

show abstract

“…Concomitantly, a diminished generation of components of anticoagulation and fibrinolysis further boost lung microthrombosis. Such an imbalanced coagulation system generated by copious amounts of cytokines forms DIC and triggers a decompensated thrombocytopenia via excessive aggregation and passive exhaustion of platelets among SARS-CoV-2 infected patients [ 202 ]. The list of proinflammatory cytokines with steady state function and association with SARS-CoV-2 related hypercoagulopathy is summarized in Table 1 .…”

Section: Sars-cov-2 and Its Receptors In Blood Vessel Pathophysiologymentioning

confidence: 99%

The SARS-CoV-2/Receptor Axis in Heart and Blood Vessels: A Crisp Update on COVID-19 Disease with Cardiovascular Complications

Veluswamy

Wacker

Stavridis

et al. 2021

Viruses

View full text Add to dashboard Cite

The SARS-CoV-2 virus causing COVID-19 disease has emerged expeditiously in the world and has been declared pandemic since March 2020, by World Health Organization (WHO). The destructive effects of SARS-CoV-2 infection are increased among the patients with pre-existing chronic conditions and, in particular, this review focuses on patients with underlying cardiovascular complications. The expression pattern and potential functions of SARS-CoV-2 binding receptors and the attributes of SARS-CoV-2 virus tropism in a physio-pathological state of heart and blood vessel are precisely described. Of note, the atheroprotective role of ACE2 receptors is reviewed. A detailed description of the possible detrimental role of SARS-CoV-2 infection in terms of vascular leakage, including endothelial glycocalyx dysfunction and bradykinin 1 receptor stimulation is concisely stated. Furthermore, the potential molecular mechanisms underlying SARS-CoV-2 induced clot formation in association with host defense components, including activation of FXIIa, complements and platelets, endothelial dysfunction, immune cell responses with cytokine-mediated action are well elaborated. Moreover, a brief clinical update on patient with COVID-19 disease with underlying cardiovascular complications and those who had new onset of cardiovascular complications post-COVID-19 disease was also discussed. Taken together, this review provides an overview of the mechanistic aspects of SARS-CoV-2 induced devastating effects, in vital organs such as the heart and vessels.

show abstract

“…Thrombocytopenia is a common manifestation of serious infections such as sepsis ( Ree et al, 2017 ) but also with some viral infections ( Raadsen et al, 2021 ). As the magnitude of the thrombocytopenia is related to severity of the infection, as well as patient survival, there is clear evidence of an association between platelets and infection.…”

Section: Introductionmentioning

confidence: 99%

Targeting SARS-CoV-2-Platelet Interactions in COVID-19 and Vaccine-Related Thrombosis

Cox

2021

Front. Pharmacol.

View full text Add to dashboard Cite

It is clear that COVID-19 is more than a pneumonia and is associated with a coagulopathy and multi-organ failure. While the use of anti-coagulants does reduce the incidence of pulmonary emboli, it does not help with survival. This suggests that the coagulopathy is more likely to be platelet-driven rather than thrombin-driven. There is significant evidence to suggest that SARS-CoV-2 virions directly interact with platelets to trigger activation leading to thrombocytopenia and thrombosis. I propose a model of multiple interactions between SARS-CoV-2 and platelets that has many similarities to that with Staphylococcus aureus and Dengue virus. As platelet activation and thrombosis are major factors in poor prognosis, therapeutics that target the platelet-SARS-CoV-2 interaction have potential in treating COVID-19 and other virus infections.

show abstract

Thrombocytopenia in Virus Infections

Cited by 78 publications

References 251 publications

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

The SARS-CoV-2/Receptor Axis in Heart and Blood Vessels: A Crisp Update on COVID-19 Disease with Cardiovascular Complications

Targeting SARS-CoV-2-Platelet Interactions in COVID-19 and Vaccine-Related Thrombosis

Contact Info

Product

Resources

About