Cerebral Venous Sinus Thrombosis With Severe Thrombocytopenia: A Fatal Adverse Event Following Johnson & Johnson COVID-19 Vaccination

Approximately 7.98 million doses of the Johnson and Johnson adenovirus vector SARS-CoV-2 vaccine (J&J vaccine) have been administered since EUA authorization by the FDA on February 27, 20211, 2. On April 13th, the CDC/FDA recommended a pause in administration after 6 cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia were identified through the vaccine adverse event reporting system in women aged 18-48. To date, 15 cases of thrombosis with thrombocytopenia syndrome (TTS) have been reported following vaccination with J&J, with three reported fatalities2. Here we report one of those fatalities in a 35-year-old woman who developed CVST with thrombocytopenia following vaccination with the J&J vaccine.

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Extensive cerebral venous sinus thrombosis after romiplostim treatment for immune thrombocytopenia (ITP) despite severe thrombocytopenia

Internal Medicine Journal ◽

10.1111/imj.12765 ◽

2015 ◽

Vol 45 (6) ◽

pp. 682-683 ◽

Cited By ~ 3

Author(s):

P. Ho ◽

S. Khan ◽

D. Crompton ◽

L. Hayes

Keyword(s):

Immune Thrombocytopenia ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Severe Thrombocytopenia ◽

Venous Sinus Thrombosis

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Cerebral Venous Sinus Thrombosis and Thrombotic Events After Vector-Based COVID-19 Vaccines: A Systematic Review and Meta-analysis

Neurology ◽

10.1212/wnl.0000000000012896 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012896

Author(s):

Lina Palaiodimou ◽

Maria-Ioanna Stefanou ◽

Aristeidis H. Katsanos ◽

Diana Aguiar de Sousa ◽

Jonathan M. Coutinho ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Sinus Thrombosis ◽

Meta Analysis ◽

Thrombotic Event ◽

Adenovirus Vector ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Thrombotic Risk ◽

Venous Sinus Thrombosis

Background and Objectives:There is accumulating evidence supporting an association between the “thrombosis and thrombocytopenia syndrome” (TTS) and adenovirus vector-based vaccines against SARS-CoV-2. Yet, TTS and TTS-associated cerebral venous sinus thrombosis (CVST) remain poorly characterized. We aim to systematically evaluate the proportion of CVST among TTS cases and assess its characteristics and outcomes.Methods:We performed a systematic review and meta-analysis of clinical trials, cohorts, case series and registry-based studies with the aim to assess (1) the pooled mortality rate of CVST, TTS-associated CVST, and TTS and (2) the pooled proportion of patients with CVST among patients with any thrombotic event and TTS. Secondary outcomes comprised clinical characteristics of patients with post-vaccination thrombotic event. This meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology proposal.Results:Sixty-nine studies were included in the qualitative analysis comprising 370 patients with CVST out of 4182 patients with any thrombotic event associated with SARS-CoV-2 vector-based vaccine administration. Twenty-three studies were further included in quantitative meta-analysis. Among TTS cases, the pooled proportion of CVST was 51% (95%CI:36-66%; I2=61%). TTS was independently associated with a higher likelihood of CVST, when compared to non-TTS patients with thrombotic events after vaccination (OR:13.8; 95%CI:2.0-97.3; I2=78%). The pooled mortality rates of TTS and TTS-associated CVST were 28% (95%CI:21-36%) and 38% (95%CI:27-49%), respectively. Thrombotic complications developed within 2 weeks of exposure to vector-based SARS-CoV-2 vaccines (mean interval:10 days; 95%CI:8-12) and affected predominantly women (69%, 95%CI:60-77%), under the age of 45, even in the absence of pro-thrombotic risk factors.Discussion:Approximately one half of TTS cases present with CVST, while almost one third of TTS patients do not survive. Further research is required to identify independent predictors of TTS following adenovirus vector-based vaccination.Registration:The pre-specified study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (CRD42021250709).

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Refractory Heparin-Induced Thrombocytopenia With Cerebral Venous Sinus Thrombosis Treated With IVIg, Steroids, and a Combination of Anticoagulants: A Case Report

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619832324 ◽

2019 ◽

Vol 7 ◽

pp. 232470961983232 ◽

Cited By ~ 3

Author(s):

Mia Gonzales ◽

Amrish Pipalia ◽

Andrew Weil

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Small Subset ◽

Severe Thrombocytopenia ◽

Platelet Factor ◽

Heparin Induced Thrombocytopenia ◽

Venous Sinus Thrombosis ◽

Increased Risk ◽

Risk For Thrombosis

Heparin-induced thrombocytopenia (HIT) type II is caused by antibody production that bind complexes between heparin and platelet factor 4 leading to platelet consumption and thrombosis. In a small subset of cases referred to as autoimmune HIT, the antibodies activate platelets even in the absence of heparin. Refractory HIT is a type of autoimmune HIT in which thrombocytopenia persists for weeks after heparin discontinuation and carries increased risk for thrombosis and more severe thrombocytopenia. We present a case of refractory HIT with cerebral venous sinus thrombosis (CVST) that was successfully treated with a change in anticoagulant alongside steroids and a second trial of intravenous immunoglobulin (IVIg).

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