Marc E Wolf1,2, Beate Luz3, Ludwig Niehaus4, Pervinder Bhogal5, Hansjörg Bäzner1,2, Hans Henkes6,7. 1. Neurologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany. 2. Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, D-68167 Mannheim, Germany. 3. Zentralinstitut für Transfusionsmedizin und Blutspendedienst, Klinikum Stuttgart, D-70174 Stuttgart, Germany. 4. Neurologie, Rems-Murr-Klinikum Winnenden, D-71364 Winnenden, Germany. 5. Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1FR, UK. 6. Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany. 7. Medical Faculty, University Duisburg-Essen, D-47057 Duisburg, Germany.
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.
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.
Authors: Patricia Mouta Nunes de Oliveira; Daniela P Mendes-de-Almeida; Victor Bertollo Gomes Porto; Catherine Crespo Cordeiro; Gabriellen Vitiello Teixeira; Renata Saraiva Pedro; Paulo Roberto Gomes Takey; Letícia Kegele Lignani; Janaína Reis Xavier; Vitor Cardoso Doria da Gama; Luiz Amorim Filho; Bárbara Emoingt Furtado; André Santa Maria; Tiago Dahrug Barros; Livia Neves Waite Freitas; Tainá Dos Santos Pereira; Debora Lima Abreu; Michael Bernardes Ramos; Caroline Gabe; Donald Arnold; James William Smith; Ishac Nazy; Maria de Lourdes de Sousa Maia Journal: Vaccine Date: 2022-06-16 Impact factor: 4.169