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Open AccessArticle

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

1
Neurologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
2
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, D-68167 Mannheim, Germany
3
Zentralinstitut für Transfusionsmedizin und Blutspendedienst, Klinikum Stuttgart, D-70174 Stuttgart, Germany
4
Neurologie, Rems-Murr-Klinikum Winnenden, D-71364 Winnenden, Germany
5
Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1FR, UK
6
Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
7
Medical Faculty, University Duisburg-Essen, D-47057 Duisburg, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Angelo Claudio Molinari
J. Clin. Med. 2021, 10(8), 1599; https://doi.org/10.3390/jcm10081599
Received: 31 March 2021 / Revised: 5 April 2021 / Accepted: 6 April 2021 / Published: 9 April 2021
(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)
Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena. View Full-Text
Keywords: COVID-19 vaccine AstraZeneca; venous sinus thrombosis; platelet factor 4 antibodies; rheolysis; anticoagulation COVID-19 vaccine AstraZeneca; venous sinus thrombosis; platelet factor 4 antibodies; rheolysis; anticoagulation
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MDPI and ACS Style

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

AMA Style

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 Style

Wolf, Marc E.; Luz, Beate; Niehaus, Ludwig; Bhogal, Pervinder; Bäzner, Hansjörg; Henkes, Hans. 2021. "Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure" J. Clin. Med. 10, no. 8: 1599. https://doi.org/10.3390/jcm10081599

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