Thrombocytopenia and intracranial venous sinus thrombosis after “COVID-19 vaccine AstraZeneca” exposure

• Verfasst von: Wolf, Marc [VerfasserIn]
• Verfasst von: Luz, Beate [VerfasserIn]
• Verfasst von: Niehaus, Ludwig [VerfasserIn]
• Verfasst von: Bhogal, Pervinder [VerfasserIn]
• Verfasst von: Bäzner, Hansjörg [VerfasserIn]
• Verfasst von: Henkes, Hans [VerfasserIn]
• Titel: Thrombocytopenia and intracranial venous sinus thrombosis after “COVID-19 vaccine AstraZeneca” exposure
• Verf.angabe: Marc E. Wolf, Beate Luz, Ludwig Niehaus, Pervinder Bhogal, Hansjörg Bäzner and Hans Henkes
• E-Jahr: 2021
• Jahr: 9 April 2021
• Umfang: 10 S.
• Fussnoten: Gesehen am 16.08.2021
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2021
• Band/Heft Quelle: 10(2021), 8, Artikel-ID 1599, Seite 1-10
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm10081599
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: anticoagulation
• Sach-SW: COVID-19 vaccine AstraZeneca
• Sach-SW: platelet factor 4 antibodies
• Sach-SW: rheolysis
• Sach-SW: venous sinus thrombosis
• K10plus-PPN: 1767100493

Abstract

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.