Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure
Abstract
:1. Introduction
2. Methods
- Anti-factor Xa (anti-Xa) assay: COAMATIC HEPARIN (Chromogenix, Bedford, MA USA) calibrated for low-molecular-weight heparin (LMWH) or rivaroxaban or apixaban, a calibration for danaparoid is not available. The anti-factor Xa-activity calibrated against LMWH was used, which might yield false-low results.
- Antithrombin activity: Berichrom Antithrombin III (A) (Siemens, Munich, Germany);
- ARCHITECT SARS-CoV-2 IgG (Abbott, Abbott Park, IL USA)
- Beta-2-glycoprotein I antibody test: ELISA (Euroimmun, Lübeck, Germany);
- Cardiolipin antibody: ELISA (Euroimmun)
- Hemostasis analyzer: CS5100-Gerät (Sysmex, Kobe, Japan)
- Heparin-induced platelet activation (HIPA), according to Greinacher et al. (https://www2.medizin.unigreifswald.de/transfus/fileadmin/user_upload/doku_thrombo_gerinnung/anleitung_hipa.pdf; accessed on 1 March 2021)
- Lupus anticoagulant (functional): Pathromtin SL (aPTT) (Siemens) and LA 1 Screen (dRVVT)/LA2 Confirm (dRVVT) (Siemens)
- Heparin-induced thrombocytopenia platelet factor 4 antibody (PF4)-IgG EIA (Immucor, Dreieich, Germany) (in the presence of high heparin concentration the ELISA was negative)
- Protein C activity: ProC AcR (Siemens)
- Protein S activity: Protein S Ac (Siemens)
- SARS-CoV-2 antibody test: LIAISON SARS-CoV-2 S1/S2 IgG (DiaSorin, Saluggia, Italy).
3. Results
3.1. Patient #1
3.2. Patient #2
3.3. Patient #3
3.4. Common Features of the Three Patients
4. Discussion
4.1. Pathophysiology
4.1.1. Intracranial Venous Sinus Thrombosis (IVST)
4.1.2. IVST and COVID-19
4.1.3. Thrombocytopenia and Thromboembolic Complications
- Mittelmeier (1959) [19]: active diphtheria vaccination in a 15-month-old boy who died two days after the second vaccination; autopsy showed generalized endothelial damage and thrombosis of the superior sagittal and straight sinus;
- Nieminen et al. (1993) [20]: measles–mumps–rubella vaccination, incidence 23/700,000, benign course, no thromboembolic complications;
- Hamiel et al. (2016) [21]: pediatric case, three occurrences;
- Yamamoto et al. (2020) [22]: influenza vaccination, the onset of alveolar hemorrhage within one day after exposure.
4.2. Therapeutic Considerations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Patient #1 | Patient #2 | Patient #3 | |
---|---|---|---|
Age (years) | 22 | 46 | 36 |
Onset of headache(days after vaccination) | 4 | 8 | 7 |
Focal neurologic symptoms (days after vaccination) | 7 | 13 | 17 |
Focal symptoms | generalized epileptic seizures | mild aphasia, homonymous hemianopia to the right | aphasia, reduced consciousness |
Platelet count upon admission (n/µL) | 75.000 | 60.000 | 92.000 |
COVID-spike-Ab (AU/mL) | +(19.8) | +(19.1) | +(75) |
HIPA-Ab | − | − | − |
PF4-Ab | + | + | + |
ADAMTS-13-activity | normal (76%) | normal (73%) | normal (86%) |
Antiphopholipid-Abs | − | − | − |
D-Dimer (ng/mL) | 2590 | 22,800 | 2120 |
Protein C activity | normal | normal | normal |
Protein S activity | normal | normal | normal |
Prothrombin G20210A | wild type | wild type | wild type |
Factor V R5066 (Leiden) | wild type | wild type | wild type |
Homocysteine (µmol/L) | 19.7 | 5.5 | 17.1 |
MTHFR | wild type | NA | heterozygote mutation (C667T) |
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Wolf, M.E.; Luz, B.; Niehaus, L.; Bhogal, P.; Bäzner, H.; Henkes, H. Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure. J. Clin. Med. 2021, 10, 1599. https://doi.org/10.3390/jcm10081599
Wolf ME, Luz B, Niehaus L, Bhogal P, Bäzner H, Henkes H. Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure. Journal of Clinical Medicine. 2021; 10(8):1599. https://doi.org/10.3390/jcm10081599
Chicago/Turabian StyleWolf, Marc E., Beate Luz, Ludwig Niehaus, Pervinder Bhogal, Hansjörg Bäzner, and Hans Henkes. 2021. "Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure" Journal of Clinical Medicine 10, no. 8: 1599. https://doi.org/10.3390/jcm10081599