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

Neurologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, D-68167 Mannheim, Germany
Zentralinstitut für Transfusionsmedizin und Blutspendedienst, Klinikum Stuttgart, D-70174 Stuttgart, Germany
Neurologie, Rems-Murr-Klinikum Winnenden, D-71364 Winnenden, Germany
Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1FR, UK
Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
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;
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.

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.

Chicago/Turabian Style

Wolf, 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.

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