scholarly journals Malignant cerebral infarction, systemic venous thrombosis and thrombocytopenia after ChAdOx1 nCov vaccination: a possible catastrophic variant of vaccine induced thrombotic thrombocytopenia

2021 ◽  
Author(s):  
Manuela De Michele ◽  
Marta Iacobucci ◽  
Ettore Nicolini ◽  
Antonio Chistolini ◽  
Fabio Pulcinelli ◽  
...  
Keyword(s):  
Young Adults ◽  
Portal Vein ◽  
Cerebral Infarction ◽  
Venous Thrombosis ◽  
Middle Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Cerebral Venous Thrombosis ◽  
Platelet Factor ◽  
Vein Thrombosis ◽  
High Level

Abstract Vaccine induced thrombotic thrombocytopenia is a new syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine and characterized by cerebral venous thrombosis. We report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia within 10 days after vaccination with ChAdOx1 nCoV-19. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both the patients had pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes.

scholarly journals Malignant cerebral infarction after ChAdOx1 nCov-19 vaccination: a catastrophic variant of vaccine-induced immune thrombotic thrombocytopenia

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
M. De Michele ◽  
M. Iacobucci ◽  
A. Chistolini ◽  
E. Nicolini ◽  
F. Pulcinelli ◽  
...  
Keyword(s):  
Young Adults ◽  
Adverse Effects ◽  
Portal Vein ◽  
Cerebral Infarction ◽  
Decompressive Craniectomy ◽  
Arterial Thrombosis ◽  
Platelet Factor ◽  
Vein Thrombosis ◽  
The Past ◽  
High Level

AbstractVaccine-induced thrombotic thrombocytopenia with cerebral venous thrombosis is a syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine. Here we report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia 9-10 days following ChAdOx1 nCoV-19 vaccination. The two cases arrived in our facility around the same time but from different geographical areas, potentially excluding epidemiological links; meanwhile, no abnormality was found in the respective vaccine batches. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two prior, successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both patients manifested pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes. None of the patients had ever received heparin in the past before stroke onset. Our observations of rare arterial thrombosis may contribute to assessment of possible adverse effects associated with COVID-19 vaccination.

scholarly journals Cerebral venous thrombosis and portal vein thrombosis: a retrospective cohort study of 537,913 COVID-19 cases

2021 ◽  
Author(s):  
Maxime Taquet ◽  
Masud Husain ◽  
John R Geddes ◽  
Sierra Luciano ◽  
Paul Harrison
Keyword(s):  
Cohort Study ◽  
Portal Vein ◽  
Venous Thrombosis ◽  
Portal Vein Thrombosis ◽  
Retrospective Cohort Study ◽  
Cerebral Venous Thrombosis ◽  
Retrospective Cohort ◽  
Matched Cohort ◽  
Vein Thrombosis ◽  
Icd 10

Objectives: To estimate the absolute risk of cerebral venous thrombosis (CVT) and portal vein thrombosis (PVT) in the two weeks following a diagnosis of COVID-19, and to assess the relative risks (RR) compared to influenza or the administration of an mRNA vaccine against COVID-19. Design: Retrospective cohort study based on an electronic health records network Setting: Linked records between primary and secondary care centres within 59 healthcare organisations, primarily in the USA Participants: All patients with a confirmed diagnosis of COVID-19 between January 20, 2020 and March 25, 2021 were included (N=537,913, mean [SD] age: 46.2 [21.4] years; 54.9% females). Cohorts (matched for age, sex, and race) of participants diagnosed with influenza (N=392,424) or receiving the BNT162b2 or mRNA-1273 vaccine (N=366,869) were used for comparison. Main outcome measures: Diagnosis of CVT (ICD-10 code I67.6) or PVT (ICD-10 code I81) within 2 weeks after a diagnosis of COVID-19. Results: The incidence of CVT after COVID-19 diagnosis was 42.8 per million people (95% CI 28.5-64.2) including 35.3 per million (95% CI 22.6-55.2) first diagnoses. This was significantly higher than the CVT incidence in a matched cohort of patients with influenza (RR=3.83, 95% CI 1.56-9.41, P<0.001) and people who received an mRNA vaccine (RR=6.67, 95% CI 1.98-22.43, P<0.001). The incidence of PVT after COVID-19 diagnosis was 392.3 per million people (95% CI 342.8-448.9) including 175.0 per million (95% CI 143.0-214.1) first diagnoses. This was significantly higher than the PVT incidence in a matched cohort of patients with influenza (RR=1.39, 95% CI 1.06-1.83, P=0.02) and people who received an mRNA vaccine (RR=7.40, 95% CI 4.87-11.24, P<0.001). Mortality after CVT and PVT was 17.4% and 19.9% respectively. Conclusions: The incidence of CVT and PVT is significantly increased after COVID-19. The data highlight the risk of serious thrombotic events in COVID-19 and can help contextualize the risks and benefits of vaccination in this regard.

Platelet Coagulant Activities and Retinal Vein Thrombosis

1977 ◽  
Vol 38 (02) ◽  
pp. 0399-0406 ◽  
Author(s):  
Peter N. Walsh ◽  
Richard E. Goldberg ◽  
Richard L. Tax ◽  
Larry E. Magargal
Keyword(s):  
Platelet Aggregation ◽  
Venous Thrombosis ◽  
Retinal Vein Occlusion ◽  
Serotonin Release ◽  
Platelet Factor ◽  
Trigger Mechanism ◽  
Local Conditions ◽  
Plasma Coagulation ◽  
Vein Thrombosis ◽  
Vein Occlusion

SummaryTo determine whether platelets play a role in the pathogenesis of retinal vein occlusion (RVO), platelets and coagulation were evaluated in 28 patients with RVO. Platelet coagulant activities concerned with the initiation and early stages of intrinsic coagulation were 2–4 fold increased in 9 patients with acute primary RVO but not in patients with acute secondary (10 patients) or chronic (9 patients) RVO. Platelet factor 3 activity, platelet aggregation, serotonin release by platelets and plasma coagulation were normal in all patients. Platelets may provide a trigger mechanism for venous thrombosis in the eye when local conditions permit.

scholarly journals Cerebral Venous Thrombosis: What's New?

2021 ◽  
Vol 41 (01) ◽  
pp. 025-030
Author(s):  
Diana Aguiar de Sousa
Keyword(s):  
Young Adults ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Cerebral Veins ◽  
Cerebrovascular Disorder ◽  
Recent Advances ◽  
Children And Young Adults

AbstractThrombosis of the cerebral veins and sinuses (CVT) is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects children and young adults, especially women. In this review, we will summarize recent advances on the knowledge of patients with CVT.

Validation of ICD-10 codes shows intracranial venous thrombosis incidence to be higher than previously reported

2018 ◽  
Vol 49 (1) ◽  
pp. 58-61 ◽  
Author(s):  
Joel D Handley ◽  
Hedley CA Emsley
Keyword(s):  
Positive Predictive Value ◽  
Cerebral Infarction ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
International Classification Of Diseases ◽  
Coding System ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
In Pregnancy

Background: Intracranial venous thrombosis (ICVT) accounts for around 0.5% of all stroke cases. There have been no previously published studies of the International Classification of Diseases, Tenth Edition (ICD-10) validation for the identification of ICVT admissions in adults. Objective: The aims of this study were to validate and quantify the performance of the ICD-10 coding system for identifying cases of ICVT in adults and to derive an estimate of incidence. Method: Administrative data were collected for all patients admitted to a regional neurosciences centre over a 5-year period. We searched for the following ICD-10 codes at any position: G08.X (intracranial and intraspinal phlebitis and thrombophlebitis), I67.6 (non-pyogenic thrombosis of intracranial venous system), I63.6 (cerebral infarction due to cerebral venous thrombosis, non-pyogenic), O22.5 (cerebral venous thrombosis in pregnancy) and O87.3 (cerebral venous thrombosis in the puerperium). Results: Sixty-five admissions were identified by at least one of the relevant ICD-10 codes. The overall positive predictive value (PPV) for confirmed ICVT from all of the admissions combined was 92.3% (60 out of 65) with the results for each code as follows: G08.X 91.5% (54 of 59), O22.5 100% (4 of 4), I67.6 100% (1 of 1), I63.6 100% (1 of 1) and O87.3 100% (1 of 1). There were 40 unique cases of ICVT over a 5-year period giving an annual incidence of ICVT of 5 per million. Conclusions: All codes gave a high PPV. Implications for practice: As demonstrated in previous studies, the incidence of ICVT may be higher than previously thought.

Abstract 525: Cases with Uncommon Anti-phospholipid Antibody Syndrome Developed Multifocal Vascular Disorders Such as Ischemic Enteritis, Portal Vein Thrombosis, Ischemic Heart Disease and Cerebral Infarction

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Yasutaka Kawamura ◽  
So Nakaji ◽  
Nobuto Hirata
Keyword(s):  
Heart Disease ◽  
Coronary Angiography ◽  
Portal Vein ◽  
Cerebral Infarction ◽  
Ischemic Heart Disease ◽  
Portal Vein Thrombosis ◽  
Ischemic Heart ◽  
Vascular Disorders ◽  
Vein Thrombosis ◽  
Ischemic Enteritis

Purpose: We report cases with uncommon anti-phosholipid antibody syndrome developed ischemic enteritis, portal vein thrombosis, ischemic heart disease and cerebral infarction. The difficulty in diagnosing and treatment procedures for multifocal vascular disorders is discussed. Patients and Methods: Patient 1, 76-year-old man, with acute abdomen. Patient 2, 54-year-old man, with intractable esophageal varices. Clinical manifestation was superior mesenteric artery (SMA) thrombosis in the patient 1 and portal vein thrombosis in the patient 2. Serial CT scans were examined on 64 or 80 multidetector-row CT (Toshiba), with bolus injection of contrast media for CT angiography (CTA). Abdominal angiography with endovascular intervention and coronary angiography were performed on Allura Xper FD-20 and FD-10 (Philips). Results: Emergency CTA of patient 1 showed decreased contrast enhancement of SMA and SMV but enhancement of intestinal walls were well preserved. Although the patient’s symptom got better, follow-up CT revealed the growth of SMA thrombosis. The aspiration and the dissolution of SMA thrombosis were performed through the SMA catheter for five days resulted in complete recanalization.Then he felt chest oppression and 75% stenosis of RCA segment 4, followed by complete spastic occlusion on Acetylcholine loading on the coronary angiography, which recovered perfectly with intra-coronary nitroglycerin administration. He discharged our hospital with health, while he had cerebellar infarction with right cerebellar artery occlusion. On patient 2, to resolve portal hypertension, balloon-occluded retrograde transvenous obliteration was scheduled, however, due to numerous collaterals prevented the effective venous obliteration and splenic arterial embolization was selected alternatively. Discussion and Conclusions: The progressive SMA thrombosis with coronary disease and subsequent cerebellar occlusion seen in patient 1, and the portal vein thrombosis in patient 2 without chronic hepatitis nor cirrhosis were unusual. To discover underlining uncommon anti-phosholipid antibody syndrome is important to prevent serious vascular diseases in sequence.

Portal Vein Thrombosis after Laparoscopic Colectomy: Thrombolytic Therapy via the Superior Mesenteric Vein

2005 ◽  
Vol 71 (10) ◽  
pp. 856-860 ◽  
Author(s):  
George A. Poultsides ◽  
W. Cannon Lewis ◽  
Robert Feld ◽  
David L. Walters ◽  
David A. Cherry ◽  
...  
Keyword(s):  
Portal Vein ◽  
Thrombolytic Therapy ◽  
Venous Thrombosis ◽  
Portal Vein Thrombosis ◽  
Superior Mesenteric Vein ◽  
Right Hemicolectomy ◽  
Published Data ◽  
Mesenteric Vein ◽  
Vein Thrombosis ◽  
Laparoscopic Assisted

Portal vein thrombosis is a rare but well-reported complication after laparoscopic surgery. We present a case of portomesenteric venous thrombosis that occurred 8 days after a laparoscopic-assisted right hemicolectomy. Systemic anticoagulation failed to improve symptoms. The early postoperative state precluded the use of transarterial thrombolytic therapy. Transjugular intra-hepatic catheter-directed infusion of urokinase into the superior mesenteric vein resulted in clearance of thrombus and resolution of symptoms. The published data on laparoscopy-induced splanchnic venous thrombosis and transjugular intrahepatic intramesenteric thrombolysis are discussed.

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