Vaccine-Induced Thrombocytopenia with Severe Headache

SARS-CoV-2 vaccines have been carefully developed and significantly alleviate the global pandemic. However, a rare but severe complication after vaccination of adenoviral vector vaccines has attracted worldwide attention. It is characterized by thrombosis at unusual sites (often cerebral or abdominal), thrombocytopenia, and the presence of antibodies against platelet factor 4 (PF4), termed vaccine-induced immune thrombotic thrombocytopenia (VITT). Its pathogenesis is similar to that of heparin-induced thrombocytopenia (HIT). VITT progresses rapidly and has a high mortality rate. Clinicians and the public should raise their vigilance to this disease so that accurate and timely treatment is provided.

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“…These patients might develop typical CVST after a few days. Salih et al defined this phenomenon as pre-VITT syndrome [32] .…”

Section: Diagnosismentioning

confidence: 99%

“…If VITT is diagnosed, patients should be transferred to a tertiary hospital, and the condition should be assessed in time. Pre-VITT is at imminent risk for CVST and CVST can be prevented with immediate therapy [32] . Treatment includes the following ( Fig.…”

Section: Treatmentmentioning

confidence: 99%

SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia

Liu

Shao

Wang

2022

Thrombosis Research

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“…Salih et al recently introduced the concept of a « pre-VITT syndrome» for those with severe headache, high d-dimer levels, positive anti–PF4 antibodies but no CVST or other thromboses [ 17 ]. Severe headache did not develop secondary to CVST but instead proceeded CVST.…”

Section: To the Editormentioning

confidence: 99%

Time to consider neuroinflammation as a booster effect of cerebral venous sinus thrombosis in vaccine-induced immune thrombotic thrombocytopenia?

Marchandot

Carmona

Morel

2021

J Thromb Thrombolysis

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“…Further, VITT-patients can present with severe headaches in this time window in the absence of thrombosis. This "pre-VITT syndrome" was described, including headache as the major symptom [8]. VITT is caused by IgG antibodies directed against platelet factor 4 (PF4), which activate platelets via their FcgRIIa receptors [1].…”

Section: Introductionmentioning

confidence: 99%

Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report

et al. 2021

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Background and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, how long symptomatic VITT can persist. Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies. Methods: Clinical and laboratory findings are presented, including the course of platelet counts, D-Dimer levels, clinical presentation, imaging, SARS-CoV-2-serological and immunological, platelet activating anti-PF4-IgG, as well as autopsy findings. Results: The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient’s serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage. Conclusions: Complicated VITT with extremely high anti-PF4-IgG titers over three months can induce recurrent thrombocytopenia despite treatment with IVIG and anticoagulation. Plasma exchange, immunoadsorption, and /or immunosuppressive treatment may be considered in complicated VITT to reduce extraordinarily high levels of anti-PF4-IgG. Long-term therapy in such cases must take the individual bleeding risk and CSVT risk into account.

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Vaccine-Induced Thrombocytopenia with Severe Headache

Cited by 75 publications

References 4 publications

SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia

SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia

Time to consider neuroinflammation as a booster effect of cerebral venous sinus thrombosis in vaccine-induced immune thrombotic thrombocytopenia?

Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report

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