Thrombocytopenia and Intracranial Venous Sinus Thrombosis after "COVID 19 Vaccine AstraZeneca" Exposure
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.
Journal of clinical medicine