scholarly journals A case of thrombocytopenia and multiple thromboses after vaccination with ChAdOx1 nCoV-19 against SARS-CoV-2

2021 ◽  
Vol 5 (12) ◽  
pp. 2569-2574
Author(s):  
Anne Louise Tølbøll Sørensen ◽  
Magalie Rolland ◽  
Jacob Hartmann ◽  
Zitta Barrella Harboe ◽  
Casper Roed ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Cerebral Vein ◽  
Platelet Factor ◽  
Oral Contraceptive Pills ◽  
Vein Thrombosis ◽  
Contraceptive Pills ◽  
Prothrombin Mutation ◽  
Vectored Vaccine ◽  
Clinical Awareness

Recently, reports of severe thromboses, thrombocytopenia, and hemorrhage in persons vaccinated with the chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19, AZD1222, Vaxzevria; Oxford/AstraZeneca) against severe acute respiratory syndrome coronavirus 2 have emerged. We describe an otherwise healthy 30-year-old woman who developed thrombocytopenia, ecchymosis, portal vein thrombosis, and cerebral venous sinus thrombosis the second week after she received the ChAdOx1 nCoV-19 vaccine. Extensive diagnostic workup for thrombosis predispositions showed heterozygosity for the prothrombin mutation, but no evidence of myeloproliferative neoplasia or infectious or autoimmune diseases. Her only temporary risk factor was long-term use of oral contraceptive pills (OCPs). Although both the prothrombin mutation and use of OCPs predispose to portal and cerebral vein thrombosis, the occurrence of multiple thromboses within a short time and the associated pattern of thrombocytopenia and consumption coagulopathy are highly unusual. A maximum 4T heparin-induced thrombocytopenia (HIT) score and a positive immunoassay for anti-platelet factor 4/heparin antibodies identified autoimmune HIT as a potential pathogenic mechanism. Although causality has not been established, our case emphasizes the importance of clinical awareness. Further studies of this potentially new clinical entity have suggested that it should be regarded as a vaccine-induced immune thrombotic thrombocytopenia.

scholarly journals Etiological associations of Cerebral Venous Sinus Thrombosis (CVT) among Sudanese patients in Khartoum state Neurological Centers, Sudan, 2020

2021 ◽  
Author(s):  
Mohamed Malekaldar ◽  
Abbasher Hussien ◽  
Khabab Abbasher Hussien Mohamed Ahmed ◽  
Yassin Abdalla
Keyword(s):  
Oral Contraceptive ◽  
Sinus Thrombosis ◽  
Post Partum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Oral Contraceptive Pills ◽  
Venous Sinus Thrombosis ◽  
Contraceptive Pills ◽  
Work Up ◽  
Treatable Condition

Abstract Background As cerebral venous sinus thrombosis is common in our country and it carries a high risk of morbidity and mortality if it is not detected and treated early. The common aetiological associations of CVST are post-partum, pregnancy and oral contraceptive pills. Objectives To study the etiological association of CVST among Sudanese patients in Khartoum state in neurological centers. Methodology This is a descriptive prospective hospital based study was conducted on CVST patients in four neurological centers in Khartoum state in the period from March to October 2020. Results Sixty patients were studied for etiological association of CVST using standardized questionnaire including medical history, clinical examination, investigation and treatment. The most common etiological association were pregnancy in 15(25%) OCP in 11(18.3) and being in the post-partum period in 23(38.3%). Recommendation Cerebral venous sinus thrombosis is a treatable condition and has good outcome. Early detection of patients and performing suitable work up including thrombophilia and connective tissue disease screening is essential. Conclusion Post-partum, pregnancy and oral contraceptive pills were the most common etiological associations of cerebral venous sinus thrombosis compared with other populations.

scholarly journals Prothrombotic immune thrombocytopenia after COVID-19 vaccine

Blood ◽  
2021 ◽  
Author(s):  
Andreas Tiede ◽  
Ulrich J Sachs ◽  
Andreas Czwalinna ◽  
Sonja Werwitzke ◽  
Rolf Bikker ◽  
...  
Keyword(s):  
Healthy Donor ◽  
Immune Thrombocytopenia ◽  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Cerebral Venous Sinus Thrombosis ◽  
Dependent Manner ◽  
Thromboembolic Events ◽  
Platelet Factor ◽  
Vein Thrombosis ◽  
Heparin Anticoagulation

We report five cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis (CVST), splanchnic vein thrombosis (SVT), arterial cerebral thromboembolism, and thrombotic microangiopathy (TMA). All patients had thrombocytopenia and markedly elevated D-Dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependant manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in three patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events.

Cerebral Venous Sinus Thrombosis due to Thrombosis with Thrombocytopenia Syndrome Following Ad26.COV2.S: A First Real-World Case Report of a Male Subject

2021 ◽  
pp. 194187442110550
Author(s):  
Samia Asif ◽  
Meghana Kesireddy ◽  
Scott A. Koepsell ◽  
Marco A. Gonzalez-Castellon ◽  
Krishna Gundabolu ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Young Male ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
First Case ◽  
Control And Prevention ◽  
Underlying Pathophysiology

Thrombosis with Thrombocytopenia Syndrome (TTS) or Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) had been reported in patients receiving the Ad26.COV2.S vaccination (Johnson & Johnson [J&J]/Janssen) vaccine. They frequently presented with cerebral venous sinus thrombosis (CVST), but venous or arterial thrombosis at other locations can be present. The majority of those affected are younger adult females. Therefore, after a brief pause from April 13–23, 2021, the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) recommended caution in using this vaccine in females under 50 years. Based on the reported 28 cases of TTS after this vaccination (data till April 21, 2021) by CDC, 22 were females (78%), and 6 were male. None of those males had CVST but had thrombosis at other locations. We report the first case of a young male with TTS and CVST following Ad26.COV2.S vaccine presented with severe headache and diagnosed with acute right transverse and sigmoid cerebral venous sinus thrombosis, multiple right-sided pulmonary emboli, and right hepatic vein thrombosis. He was treated with parenteral anticoagulation with argatroban and intravenous immune globulin with the improvement of his symptoms. A heparin-induced thrombocytopenia with thrombosis (HITT) like syndrome caused by the genesis of a platelet-activating autoantibody against platelet factor 4 (PF4) triggered by adenoviral vector-based COVID-19 vaccinations is understood to be the underlying pathophysiology. TTS with CVST should be considered when patients present with headaches, stroke-like neurological symptoms, thrombocytopenia, and symptom onset 6–15 days after Ad26.COV2.S vaccination.

scholarly journals Cerebral Vein and Sinus Thrombosis in Isfahan-Iran: A Changing Profile

2004 ◽  
Vol 31 (4) ◽  
pp. 474-477 ◽  
Author(s):  
Mohammad Saadatnia ◽  
Seyyed Ali Mousavi ◽  
Sassan Haghighi ◽  
Ashraf Aminorroaya
Keyword(s):  
Oral Contraceptive ◽  
Sinus Thrombosis ◽  
Tertiary Care ◽  
Oral Contraceptive Pill ◽  
Predisposing Factors ◽  
Diagnostic Tools ◽  
Cerebral Vein ◽  
Care Hospital ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills

Objectives:This study was performed to investigate the clinical presentation and predisposing factors for cerebral vein and sinus thrombosis (CVST) in Isfahan, Iran.Methods:Data from the records of all patients with CVSTreferred to the largest tertiary-care hospital of Isfahan during a five-year period (1997 to 2001) were extracted and reviewed.Results:The number of cases with CVST diagnosed annually was 6, 9, 11, 14 and 15 patients, respectively. Thirteen men and 42 women were diagnosed to have CVST with the mean age of 35.1± 3.8 and 28.7±1.3 years, respectively. Headache was the most frequent complaint (95%) and 63% of patients had focal neurological symptoms, including seizure (58%). Among possible predisposing factors, oral contraceptive pill was the most prevalent one, which was used by 38.1% of affected women for a period of as short as 1-3 months. Anticardiolipin antibodies were detected in 14% of patients.Conclusion:It seems that the annual incidence of CVST is increasing in Isfahan, perhaps due to more extensive intake of oral contraceptive pills and usage of more accurate modern diagnostic tools. The use of oral contraceptive pills was the most frequent predisposing factor; infections and postpartum factors were infrequently observed. Despite other reports from the Middle East, Behçet's disease is not a principal risk factor for CVST in Isfahani patients.

scholarly journals Evaluation of Estrogen level in Oral Contraceptive Pills used by the women with cerebral venous- sinus thrombosis

2017 ◽  
pp. 16
Author(s):  
Abdolreza Ghoreishi
Keyword(s):  
Oral Contraceptive ◽  
Sinus Thrombosis ◽  
Muslim Women ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Oral Contraceptive Pills ◽  
Venous Sinus Thrombosis ◽  
Estrogen Level ◽  
Contraceptive Effect ◽  
Contraceptive Pills

Introduction: Muslim women are not allowed to perform religious ceremonies in menstrual period. Some of them use oral contraceptive pills (OCPs) to delay menstruation, which can lead to cerebral venous - sinus thrombosis (CVST). Therefore, the incidence of CVST is significantly higher in Iranian women. Thrombosis incidence is directly related to estrogen level of OCPs. In this study, the estrogen level of OPCs was evaluated in a group of female CVST patients.Methods: This study was conducted from 2010 to 2011, including two consecutive months of Ramadan in Zanjan Province of Iran. The remaining tablets of patients with CVST and OCP consumption history were analyzed by HPLC method.Results: Of 32 female CVST patients, 27 patients had a history of OCPs consumption. 24 cases of them consumed LD. Analysis of LD tablets revealed normal level of estrogen except for one case.Conclusion: Using contraceptive products among Muslim women in incorrect manner to delay menstruation should be considered by healthcare system. It is recommended to decrease amount of estrogen in OCPs till their contraceptive effect is unaffected. 

Prevalence of cerebral vein thrombosis among patients with spontaneous intracranial hypotension

2021 ◽  
pp. 159101992110659
Author(s):  
M Oien ◽  
JK Cutsforth-Gregory ◽  
I Garza ◽  
NR Kissoon ◽  
CM Carr ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
Sinus Thrombosis ◽  
Spontaneous Intracranial Hypotension ◽  
Rare Condition ◽  
Cerebral Venous Sinus Thrombosis ◽  
Cerebral Vein ◽  
Imaging Findings ◽  
Arteriovenous Fistulas ◽  
Vein Thrombosis ◽  
Lobar Hemorrhage

Background and purpose Cerebral venous sinus thrombosis (CVST) is a rare condition but an important complication of spontaneous intracranial hypotension (SIH). We reviewed our experience of patients with SIH and assessed for the presence of CVST. Methods We reviewed the medical records and imaging studies from our tertiary referral institution, assessing patients with clinically suspected SIH as well as imaging findings of intracranial hypotension. All relevant brain MRIs were reviewed for the presence of brain sag, pachymeningeal enhancement, and CVST. Results Among 563 patients with a clinical diagnosis of SIH, 431 (76%) demonstrated brain sag. In the overall patient cohort, a total of 5 patients had CVST (0.9%) and all 5 of these patients demonstrated findings of brain sag. Of the patients with CVST, 3 had significant complications, including dural arteriovenous fistulas (2 patients) and lobar hemorrhage with seizure (1 patient). Conclusion SIH is a risk factor for the development of CVST. In our review of 563 patients with clinical and/or imaging findings of SIH, 0.9% of patients were diagnosed with CVST and 3 of these patients (60%) had additional severe complications.

scholarly journals Cerebral venous sinus thrombosis after ChAdOx1 nCov-19 vaccination with a misleading first cerebral MRI scan

2021 ◽  
pp. svn-2021-001095
Author(s):  
Benno Ikenberg ◽  
Antonia Franziska Demleitner ◽  
Thomas Thiele ◽  
Benedikt Wiestler ◽  
Katharina Götze ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Intravenous Immunoglobulins ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Pathological Findings ◽  
Mri Scan ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Activation Assay ◽  
Cerebral Mri

Vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST) have been recently described as rare complications following vaccination against SARS-CoV-2 with vector vaccines. We report a case of a young woman who presented with VITT and cerebral CVST 7 days following vaccination with ChAdOx1 nCov-19 (AstraZeneca). While the initial MRI was considered void of pathological findings, MRI 3 days later revealed extensive CVST of the transversal and sigmoidal sinus with intracerebral haemorrhage. Diagnostic tests including a platelet-factor-4-induced platelet activation assay confirmed the diagnosis of VITT. Treatment with intravenous immunoglobulins and argatroban resulted in a normalisation of platelet counts and remission of CVST.

scholarly journals Diagnosis and Management of Lemierre’s Syndrome Presented with Multifocal Pneumonia and Cerebral Venous Sinus Thrombosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yasar Sattar ◽  
Ammu Thampi Susheela ◽  
Bibek Karki ◽  
Adnan Liaqat ◽  
Waqas Ullah ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Fusobacterium Nucleatum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Jugular Vein Thrombosis ◽  
Lemierre Syndrome ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Cerebral Sinus Venous Thrombosis ◽  
Magnetic Resonance Imaging Mri

A 27-year-old female patient initially presented with fever, myalgia, sore throat that progressed to multifocal pneumonia, and cerebral sinus venous thrombosis. A combination of upper respiratory symptoms with tooth infection, positive blood culture for Fusobacterium nucleatum, computed tomography (CT) chest finding of multifocal pneumonia, and magnetic resonance imaging (MRI) finding of internal jugular vein thrombosis (IJVT) and cerebral venous sinus thrombosis (CVST) suggested Lemierre syndrome. The patient was managed with fluids, antibiotics, and anticoagulants. The patient survived and discharged from the hospital. The patient’s symptoms improved at 2 months of follow-up.

Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: computed tomography and magnetic resonance findings

2000 ◽  
Vol 114 (10) ◽  
pp. 798-801 ◽  
Author(s):  
Maria F. López-Peláez ◽  
José M. Millán ◽  
Joaquin de Vergas
Keyword(s):  
Sinus Thrombosis ◽  
Major Complication ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Jugular Vein Thrombosis ◽  
Cervical Mass ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Sagittal Sinus ◽  
Common Causes

Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5–30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.

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