scholarly journals Trombose, Hemorragia e Trombocitopenia Induzidas pelas Vacinas contra a COVID-19: Protocolo de Atuação

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Sara Morais ◽  
Eugénia Cruz
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Diagnosis And Treatment ◽  
Current Evidence ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Unusual Combination

After widespread vaccination with COVID-19 vaccines, there have been worldwide reports on thrombosis, bleeding, and thrombocytopenia. Recently, a rare syndrome with a high mortality rate consisting of an unusual combination of thrombocytopenia and thrombosis, in particular cerebral venous sinus thrombosis, which clinically resembles heparin-induced thrombocytopenia, was reported following vaccination. Different statements and recommendations were developed regarding the definition, diagnosis, and treatment of these rare complications. We present here a protocol with recommendations, based on current evidence.

scholarly journals Cerebral venous sinus thrombosis associated with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection

2021 ◽  
pp. 104-104
Author(s):  
Dragan Nikolic ◽  
Marijana Basta-Nikolic ◽  
Vladimir Manojlovic ◽  
Zeljko Zivanovic ◽  
Sanja Vickovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Clinical Presentation ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Neurological Symptoms ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis

Introduction/Objective. Coagulopathy induced by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) can be an underlying cause of cerebral venous sinus thrombosis (CVST), a less common type of stroke with a variable clinical presentation and high mortality rate. Objective: to present a series of CVST cases associated with SARS-CoV-2 infection. Methods. This retrospective study evaluated clinical, laboratory and radiological presentation, risk factors, barriers to diagnosis, treatment and outcome of patients with SARS-CoV-2 infection induced CVST. Results. The study comprised 6 patients diagnosed with COVID-19 induced CVST during the 18 months period. Majority (66.7%) had no significant risk factors for developing CVST. Median time from initial COVID-19 diagnosis to onset of neurologic deficit was 7 days (interquartile range 0.5-7 days). Clinical presentation comprised non specific neurological symptoms: headache (83.3%) and decreased consciousness (33.3%), together with elevated levels of D-dimer and inflammatory biomarkers. The transverse (n = 4 or 66.7%), superior sagittal sinuses (n = 3 or 50%) and sigmoid sinus (n = 2 or 33.3%) were most commonly affected. Five patients (83.3%) had minimal to no symptoms at discharge (mRS ? 2). In-hospital mortality in our current series was relatively high (16.7%). Conclusion. The high mortality rate of SARS-CoV-2-associated CVST urges clinicians to suspect CVST in patients with a history of COVID-19 infection presenting with non-specific neurological symptoms in order to provide proper treatment and prevent complications.

scholarly journals Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis

2020 ◽  
Vol 5 (2) ◽  
pp. 152-158
Author(s):  
Yuhua Fan ◽  
Jian Yu ◽  
Hongbing Chen ◽  
Jian Zhang ◽  
Jiangang Duan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Clinical Management ◽  
Sinus Thrombosis ◽  
Cerebrovascular Disorders ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Current Evidence ◽  
Current Guideline ◽  
Venous Sinus Thrombosis ◽  
Venous Thromboembolic Events

AimCerebral venous sinus thrombosis (CVST) is a less common cerebrovascular disease that predominantly affects young patients. The incidence of CVST is 2–5/10 000 000/year, accounting for 0.5%–1% of all stroke. To reduce mortality and morbidity associated with CVST, Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST.MethodsPubMed (MEDLINE), CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019. Data were synthesised by evidence tables. Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees. Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation.ResultsThis guideline mainly focuses on the diagnostic evaluation, therapeutic strategies and secondary prevention of CVST. CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST. Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately. After the acute stage, warfarin is recommended for 3–6 months to prevent the recurrence of CVST and other venous thromboembolic events.ConclusionsThe guideline summarises the current evidence regarding the management of CVST, and provides references for diagnosis, treatment and secondary prevention of CVST in China.

Spontaneous heparin-induced thrombocytopenia presenting as cerebral venous sinus thrombosis

2020 ◽  
pp. 10.1212/CPJ.0000000000000805
Author(s):  
Ginette Moores ◽  
Theodore E. Warkentin ◽  
Mohammed A.M. Farooqi ◽  
Stefan D. Jevtic ◽  
Michelle P. Zeller ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis

scholarly journals Diagnosis and treatment of headache probably attributed to cerebral venous sinus thrombosis

2014 ◽  
Vol 8 (4) ◽  
pp. 97-101
Author(s):  
Rosario Iannacchero ◽  
Amerigo Costa ◽  
Antonio Sergi ◽  
Aida Squillace ◽  
Giuseppe Vescio ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Sinus Thrombosis ◽  
Rare Condition ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Warning Signs ◽  
Venous Sinus ◽  
Diagnosis And Treatment ◽  
Secondary Headache ◽  
Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is a rare condition whose most common and sometimes only symptom is headache. Alas, diagnosis and treatment of CVST is often delayed or overlooked because of its high clinical variability. Using guidelines advices in detecting warning signs or symptoms of secondary headaches might ease the diagnosis of CVST.The article presents the case of a woman who is in treatment for chronic migraine and assessed for secondary headache in a multidisciplinary outpatient headache program. Alert symptoms like sudden worsening headache presentation, along with anamnestic cues, prompted neuroimaging that detected left transverse sinus thrombosis whose onset was difficult to date.

scholarly journals Successful endovascular therapy for cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia

2020 ◽  
Vol 26 (3) ◽  
pp. 341-345
Author(s):  
Yoshihisa Fukushima ◽  
Kenji Takahashi ◽  
Ichiro Nakahara
Keyword(s):  
Medical Treatment ◽  
Endovascular Therapy ◽  
Sinus Thrombosis ◽  
Venous Drainage ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Heparin Induced Thrombocytopenia ◽  
Venous Sinus Thrombosis ◽  
Excellent Outcome ◽  
Disturbance Of Consciousness

Introduction Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure. A limited number of studies have reported cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia. Here, we present a case of successful endovascular therapy (EVT) without periprocedural heparinization in this situation. Case presentation A 47-year-old woman taking an oral contraceptive was admitted to our hospital with severe headache to be diagnosed as cerebral venous sinus thrombosis. Initially, she got improved by medical treatment with intravenous unfractionated heparin. However, she rapidly developed disturbance of consciousness and right hemiplegia due to cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia on the 14th hospital day. She underwent emergent EVT by immediate conversion of anticoagulation from heparin to argatroban. Despite a large clot burden, sufficient recanalization and anterograde venous drainage were re-established by combined EVT including aspiration, balloon sinoplasty, and local thrombolysis with urokinase infusion. She got improved immediately after the intervention and discharged home without any neurological sequelae after two months. Conclusion This unique case of cerebral venous sinus thrombosis worsened by occurrence of heparin-induced thrombocytopenia during the treatment finally resulted in excellent outcome highlights effectiveness of emergent endovascular intervention for critical cerebral venous sinus thrombosis resistant to initial medical treatment and of immediate establishment of effective anticoagulant strategy for both of heparin-induced thrombocytopenia and cerebral venous sinus thrombosis. Neuroendovascular therapy for cerebral venous sinus thrombosis using alternative argatroban to heparin for periprocedural anticoagulation might be safe and feasible.

Sign in / Sign up

Export Citation Format

Share Document