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Pelz JO, Kenda M, Alonso A, Etminan N, Wittstock M, Niesen WD, Lambeck J, Güresir E, Wach J, Lampmannn T, Dziewas R, Wiedmann M, Schneider H, Bayas A, Christ M, Mengel A, Poli S, Brämer D, Lindner D, Pfrepper C, Roth C, Salih F, Günther A, Michalski D. Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study. Neurocrit Care 2024; 40:621-632. [PMID: 37498459 PMCID: PMC10959787 DOI: 10.1007/s12028-023-01782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome. METHODS This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS. RESULTS Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043). CONCLUSIONS Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients.
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Affiliation(s)
- Johann Otto Pelz
- Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Martin Kenda
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany
| | - Angelika Alonso
- Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Wolf-Dirk Niesen
- Department of Neurology and Clinical Neurophysiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Johann Lambeck
- Department of Neurology and Clinical Neurophysiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Tim Lampmannn
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck, Osnabrueck, Germany
| | - Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Antonios Bayas
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Monika Christ
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Dirk Brämer
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Dirk Lindner
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Christian Pfrepper
- Division of Haemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
| | - Christian Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Farid Salih
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Faghihi H, Mottaghi-Dastjerdi N, Sharifzadeh M, Rahimi Kakavandi N. ChAdOx1 nCoV-19 Vaccine and Thrombosis with Thrombocytopenia Syndrome among Adults: A Systematic Review. Adv Pharm Bull 2023; 13:723-735. [PMID: 38022808 PMCID: PMC10676559 DOI: 10.34172/apb.2023.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 12/01/2023] Open
Abstract
Several vaccine-induced thrombotic thrombocytopenia syndrome (VITTS) cases have been reported after the ChAdOx1 nCov-19 vaccination. The current study systematically reviewed the reported post-ChAdOx1 nCoV-19 vaccination thrombotic thrombocytopenia cases. Their laboratory and clinical features, as well as the diagnostic and therapeutic measures, were investigated. Online databases were searched until 25 August 2021. Studies reporting post-ChAdOx1 nCov-19 vaccination thrombotic thrombocytopenia syndrome (TTS) were included. Overall, 167 cases (21-77 years old) from 53 publications were included showing a female dominance of 1.75 times. About 85% of the cases exhibited the primary symptoms within the first two weeks post-vaccination. Headache was the most common initial symptom (>44.2%), and hemorrhage/thrombotic problems (22.46%), as well as discoordination/weakness/numbness/ hemiparesis/cyanotic toes (19.6%), were the most prevalent uncommon initial symptoms. Prothrombin time (PT), D-dimers, and C-reactive protein were the most remarkable increased laboratory parameters in 50.6%, 99.1%, and 55.6% of cases, respectively. In comparison, platelet and fibrinogen were the most remarkable decreased laboratory parameters in 92.7% and 50.5% of cases, respectively. Most VITT cases presented with cerebral venous thrombosis/cerebral venous sinus thrombosis, supraventricular tachycardia, transverse sinus/cerebral thrombosis, pulmonary embolism, and cerebral hemorrhage. Anti-PF4 antibody measurement through immunoassays and functional assays were positive in 86.2% and 73% of cases, respectively. About 31% of the cases died. Early diagnosis and proper therapeutic measures are important in ChAdOx1 nCov-19 vaccine-induced VITTS patients. Therefore, experts are recommended to know the corresponding clinical and laboratory features, as well as diagnostic methods. Elucidation of the pathophysiologic mechanism of ChAdOx1 nCov-19 vaccine-induced TTS deserves further investigation.
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Affiliation(s)
- Homa Faghihi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy Iran University of Medical Sciences, Tehran, Iran
| | - Negar Mottaghi-Dastjerdi
- Department of Pharmacognosy and Pharmaceutical Biotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sharifzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Toxicology and Poisoning Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Rahimi Kakavandi
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Suhaimi SNAA, Zaki IAH, Noordin ZM, Hussin NSM, Ming LC, Zulkifly HH. COVID-19 vaccine-induced immune thrombotic thrombocytopenia: a review. Clin Exp Vaccine Res 2023; 12:265-290. [PMID: 38025914 PMCID: PMC10655150 DOI: 10.7774/cevr.2023.12.4.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/20/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Rare but serious thrombotic incidents in relation to thrombocytopenia, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), have been observed since the vaccine rollout, particularly among replication-defective adenoviral vector-based severe acute respiratory syndrome coronavirus 2 vaccine recipients. Herein, we comprehensively reviewed and summarized reported studies of VITT following the coronavirus disease 2019 (COVID-19) vaccination to determine its prevalence, clinical characteristics, as well as its management. A literature search up to October 1, 2021 using PubMed and SCOPUS identified a combined total of 720 articles. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, after screening the titles and abstracts based on the eligibility criteria, the remaining 47 full-text articles were assessed for eligibility and 29 studies were included. Findings revealed that VITT cases are strongly related to viral vector-based vaccines, which are the AstraZeneca COVID-19 vaccine (95%) and the Janssen COVID-19 vaccine (4%), with much rarer reports involving messenger RNA-based vaccines such as the Moderna COVID-19 vaccine (0.2%) and the Pfizer COVID-19 vaccine (0.2%). The most severe manifestation of VITT is cerebral venous sinus thrombosis with 317 cases (70.4%) and the earliest primary symptom in the majority of cases is headache. Intravenous immunoglobulin and non-heparin anticoagulant are the main therapeutic options for managing immune responses and thrombosis, respectively. As there is emerging knowledge on and refinement of the published guidelines regarding VITT, this review may assist the medical communities in early VITT recognition, understanding the clinical presentations, diagnostic criteria as well as its management, offering a window of opportunity to VITT patients. Further larger sample size trials could further elucidate the link and safety profile.
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Affiliation(s)
| | - Izzati Abdul Halim Zaki
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
- Cardiology Therapeutics Research Group, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Zakiah Mohd Noordin
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
- Cardiology Therapeutics Research Group, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Nur Sabiha Md Hussin
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
| | - Hanis Hanum Zulkifly
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
- Cardiology Therapeutics Research Group, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
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Rule out all differential causes before attributing cerebral bleeding to 5-aminolevulinic acid. Childs Nerv Syst 2023; 39:847-848. [PMID: 36856853 PMCID: PMC9976666 DOI: 10.1007/s00381-023-05906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
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Muslim S, Mustafa G, Nasrin N, Firdaus A, Singh SK. An analysis of fatal adverse conditions in temporal association of COVID-19 vaccination to boost the safety of vaccination for COVID-19. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:11. [PMID: 36777902 PMCID: PMC9903264 DOI: 10.1186/s43162-023-00191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
SARS-CoV-2, the causative agent of COVID-19, claimed multiple lives in a very short span of time. Seeing the urgency of situation, vaccines were developed in hitherto unseen time frame. Vaccines definitely passed the test of safety and efficacy in clinical trials, but post mass vaccination data revealed cases of fatal adverse conditions in the temporal association of vaccination. The temporal association does not guarantee that the fatality is due to vaccination, but at the same time, it does create a concern. To overcome this concern and improve the safety of vaccination, we reviewed literature and collected data of 15 studies comprising of total 22 cases of fatal adverse condition/death in the temporal association of COVID-19 vaccination. Analysis of these data shows that many persons (40.90%) who succumbed were previously healthy individuals. All those who died developed symptoms or were admitted to hospital within a period of 3 weeks after vaccination. 86.36% cases of death took place within a period of 3 weeks after vaccination/presentation/admission/intervention. Complications which lead to death were CVST, thrombocytopenia/thrombosis /VITT, DIC and haemorrhage in 81.18% of cases. 81.81% cases of death were noted in the temporal association with ChAdOx1 nCoV-19 vaccine. 68.18% persons developed symptoms after first dose. Death was more common in females (59.09%), and the most commonly affected age group was 20 to 60 years (86.36%). Knowledge of fatal adverse conditions in the temporal association of vaccination will help to tackle these situations well and improve the safety of vaccination drive further.
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Affiliation(s)
| | - Gulam Mustafa
- grid.449644.f0000 0004 0441 5692College of Pharmacy, Shaqra University, Shaqra, 11961 Saudi Arabia
| | - Nasrin Nasrin
- Katihar Medical College & Hospital, Katihar, Bihar India
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Cleaver J, Ibitoye R, Morrison H, Flood R, Crewdson K, Marsh A, Abhinav K, Bosnell R, Crossley R, Mortimer A. Endovascular treatment for vaccine-induced cerebral venous sinus thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccination: a report of three cases. J Neurointerv Surg 2022; 14:853-857. [PMID: 34782400 DOI: 10.1136/neurintsurg-2021-018238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaccine-induced thrombosis and thrombocytopenia (VITT) is a rare complication following ChAdOx1 nCoV-19 vaccination. Cerebral venous sinus thrombosis (CVST) is overrepresented in VITT and is often associated with multifocal venous thromboses, concomitant hemorrhage and poor outcomes. Hitherto, endovascular treatments have not been reviewed in VITT-related CVST. METHODS Patient records from a tertiary neurosciences center were reviewed to identify patients who had endovascular treatment for CVST in VITT. RESULTS Patient records from 1 January 2021 to 20 July 2021 identified three patients who underwent endovascular treatment for CVST in the context of VITT. All were female and the median age was 52 years. The location of the CVST was highly variable. Two-thirds of the patients had multifocal dural sinus thromboses (sigmoid, transverse, straight and superior sagittal) as well as internal jugular vein thromboses. Intracerebral hemorrhage occurred in all patients; subarachnoid blood was noted in two of them, and intraparenchymal hemorrhage occurred in all. There was one periprocedural parenchymal extravasation which abated on temporary cessation of anticoagulation. Outcome data revealed a 90-day modified Rankin Scale (mRS) score of 2 in all cases. CONCLUSIONS We demonstrate that endovascular treatment for VITT-associated CVST is feasible and can be safe in cases that deteriorate despite medical therapy. Extensive clot burden, concomitant hemorrhage, rapid clinical progression and persistent rises in intracranial pressure should initiate multidisciplinary team discussion for endovascular treatment in appropriate cases.
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Affiliation(s)
- Jonathan Cleaver
- Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Richard Ibitoye
- Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Hamish Morrison
- Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Richard Flood
- Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Kate Crewdson
- Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Aidan Marsh
- Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Kumar Abhinav
- Neurosurgery, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Rose Bosnell
- Stroke, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Robert Crossley
- Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Alex Mortimer
- Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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Treatment-Limiting Decisions in Patients with Spontaneous Intracerebral Hemorrhage. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58080989. [PMID: 35893103 PMCID: PMC9332709 DOI: 10.3390/medicina58080989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Treatment-limiting decisions (TLDs) are employed to actively withhold treatment/invasive interventions from patients in whom clinicians feel they would derive little to no benefit and/or suffer detrimental effects. Data regarding the employment of TLDs in patients with spontaneous intracerebral hemorrhage (ICH) remain sparse. Accordingly, this study sought to investigate both the prevalence of TLDs and factors driving TLDs in patients suffering from spontaneous ICH. Materials and Methods: This was a retrospective study of 249 consecutive patients with ICH treated from 2018−2019 at the Neurovascular Center of the University Hospital Bonn. Reasons deemed critical in the decision-making process with regard to TLD were ultimately extracted/examined via chart review of qualifying patients. Results: A total of 249 patients with ICH were included within the final analyses. During the time period examined, 49 patients (20%) had advanced directives in place, whereas in 53 patients (21%) consultation with relatives or acquaintances was employed before further treatment decisions. Overall, TLD ultimately manifested in 104 patients (42%). TLD was reached within 6 h after admission in 52 patients (50%). Congruent with severity of injury and expected outcomes, TLDs were more likely in patients with signs of cerebral herniation and an ICH score > 3 (p < 0.001). Conclusions: The present study examines details associated with TLDs in patients with spontaneous ICH. These data provide insight into key decisional processes and reinforce the need for further structured investigations in an effort to help guide patients and their families.
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Special Issue “COVID-19 and Venous Thromboembolism”. J Clin Med 2022; 11:jcm11133822. [PMID: 35807107 PMCID: PMC9267248 DOI: 10.3390/jcm11133822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
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Siddig A, Abbasher Hussien Mohamed Ahmed K, Hassan Haroun MS, M. Abdallah A, Malekaldar M, Abbasher AH, Abbasher M, Abbasher AA, Hussien A. AstraZeneca COVID
‐19 vaccine: A possible risk factor for ischemic stroke and cerebral venous sagittal sinus thrombosis: A case series. Clin Case Rep 2022; 10:e6017. [PMID: 35846901 PMCID: PMC9272208 DOI: 10.1002/ccr3.6017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/21/2022] [Accepted: 06/03/2022] [Indexed: 11/12/2022] Open
Abstract
One of the most prevalent neurological impairments is cerebrovascular accident (CVA). Ischemic stroke and CVST have been linked to the AstraZeneca COVID‐19 vaccine. Three Sudanese patients developed these diseases after receiving the AstraZeneca COVID‐19 vaccine, indicating a relationship between the AstraZeneca COVID‐19 vaccine and these conditions. Ischemic stroke and CVST have been linked to the AstraZeneca vaccine. It is critical to anticipate such scenarios and educate patients about the potential adverse effects of vaccination in order to encourage them to seek medical treatment early if any symptoms appear after they have been vaccinated to avoid consequences.
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Affiliation(s)
- Amira Siddig
- Faculty of Medicine AlNeelain University Khartoum Sudan
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Ornelas-Aguirre JM, Gómez-Alcalá AV, Ramírez-Leyva DH. Increment of D-dimer Associated with Immune Thrombotic Thrombocytopenia in ChAdOx1 nCoV-19 (AstraZeneca-Oxford) Vaccinated Individuals: A Systematic Review. Arch Med Res 2022; 53:341-351. [DOI: 10.1016/j.arcmed.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
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Zamboni P, Scerrati A, Sessa F, Pomara C, Mannucci PM. Vaccine-induced immune thrombotic thrombocytopenia with atypical vein thrombosis: Implications for clinical practice. Phlebology 2022; 37:180-187. [PMID: 35068258 DOI: 10.1177/02683555211068948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a new and rare syndrome resulting from the largest vaccination campaign against SARS-CoV-2 in the history of mankind. The aim of this review is to clarify underlying mechanisms, pathology, diagnosis, and therapy, with the related clinical implications. METHODS We performed a comprehensive literature review in order to collect the clinical and treatment data about patients suffering from VITT. PubMed, Ovid Medline, Ovid EMBASE, Scopus, and Web of Science were screened regarding patients who developed VITT. Last search was launched on June 30th 2021. RESULTS Abdominal and/or neurological symptoms develop between 5 and 20 days after vaccine administration and do not involve the lower extremities. VITT is suspected if the platelet count is lower than 100.000/mm3 and D-dimer is higher than the age-adjusted range. Medical treatment is mainly based on intravenous immunoglobulins, corticosteroids, and anticoagulant drugs with a short plasma half-life, but the complete avoidance of low molecular weight heparin is recommended. Endovascular treatment and/or decompressive craniectomy might be an option in a minority of cases. CONCLUSION Due to widespread vaccination concerns, the vascular specialist and phlebologist are increasingly consulted to prevent or diagnose VITT. The latter has peculiar and completely different localizations, symptoms, and treatment compared to the common pictures of venous thrombosis.
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Affiliation(s)
- Paolo Zamboni
- Hub Center for Venous and Lymphatic Diseases Regione Emilia-Romagna, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, 9299University of Ferrara, Ferrara, Italy
| | - Alba Scerrati
- Department of Morphology, Surgery and Experimental Medicine, 9299University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, 18567University of Foggia, Foggia, Italy
| | - Cristoforo Pomara
- Institute of Legal Medicine, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 9339IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
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Wittstock M, Walter U, Volmer E, Storch A, Weber MA, Großmann A. Cerebral venous sinus thrombosis after adenovirus-vectored COVID-19 vaccination: review of the neurological-neuroradiological procedure. Neuroradiology 2022; 64:865-874. [PMID: 35184205 PMCID: PMC8929723 DOI: 10.1007/s00234-022-02914-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/03/2022] [Indexed: 01/22/2023]
Abstract
Cerebral venous and sinus thrombosis (CVST) after adenovirus-vectored COVID-19 ChAdOx1 nCov-19 (Oxford–AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson) is a rare complication, occurring mainly in individuals under 60 years of age and more frequently in women. It manifests 4–24 days after vaccination. In most cases, antibodies against platelet factor-4/polyanion complexes play a pathogenic role, leading to thrombosis with thrombocytopenia syndrome (TTS) and sometimes a severe clinical or even fatal course. The leading symptom is headache, which usually increases in intensity over a few days. Seizures, visual disturbances, focal neurological symptoms, and signs of increased intracranial pressure are also possible. These symptoms may be combined with clinical signs of disseminated intravascular coagulation such as petechiae or gastrointestinal bleeding. If TTS-CVST is suspected, checking d-dimers, platelet count, and screening for heparin-induced thrombocytopenia (HIT-2) are diagnostically and therapeutically guiding. The imaging method of choice for diagnosis or exclusion of CVST is magnetic resonance imaging (MRI) combined with contrast-enhanced venous MR angiography (MRA). On T2*-weighted or susceptibility weighted MR sequences, the thrombus causes susceptibility artefacts (blooming), that allow for the detection even of isolated cortical vein thromboses. The diagnosis of TTS-CVST can usually be made reliably in synopsis with the clinical and laboratory findings. A close collaboration between neurologists and neuroradiologists is mandatory. TTS-CVST requires specific regimens of anticoagulation and immunomodulation therapy if thrombocytopenia and/or pathogenic antibodies to PF4/polyanion complexes are present. In this review article, the diagnostic and therapeutic steps in cases of suspected TTS associated CSVT are presented.
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Affiliation(s)
- Matthias Wittstock
- Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20 18147 Rostock, Germany.
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20 18147 Rostock, Germany
| | - Erik Volmer
- Institute for Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock, Germany
| | - Alexander Storch
- Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20 18147 Rostock, Germany
| | - Marc-André Weber
- Institute for Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock, Germany
| | - Annette Großmann
- Institute for Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock, Germany
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Propensity-Score-Matched Evaluation of Adverse Events Affecting Recovery after COVID-19 Vaccination: On Adenovirus and mRNA Vaccines. Vaccines (Basel) 2022; 10:vaccines10020284. [PMID: 35214742 PMCID: PMC8875227 DOI: 10.3390/vaccines10020284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to observe adverse events following immunisation (AEFIs) that affected recovery within two weeks after COVID-19 vaccination and investigate their risks in propensity-score-matched populations. Data were collected from 447,346 reports from the VAERS between 1 January 2021 and 31 July 2021. Propensity-score-matched populations were constructed by adjusting for demographic characteristics and 11 underlying diseases in eligible subjects who received 1 of 3 COVID-19 vaccines: 19,462 Ad26.COV2.S, 120,580 mRNA-1273, and 100,752 BNT162b2. We observed that 88 suspected AEFIs (22 in Ad26.COV2.S, 62 in mRNA-1273, and 54 in BNT162b2) were associated with an increased risk of delayed recovery within 2 weeks after COVID-19 vaccinations. Nervous system, musculoskeletal and connective tissue, gastrointestinal, skin, and subcutaneous tissue disorders were the most common AEFIs after COVID-19 vaccination. Interestingly, four local and systemic reactions affected recovery in different vaccine recipients during our study period: asthenic conditions and febrile disorders in Ad26.COV2.S and mRNA-1273; general signs and symptoms in mRNA-1273 and BNT162b2; injection site reactions in Ad26.COV2.S and BNT162b2. Although it is necessary to confirm a causal relationship with COVID-19 vaccinations, some symptoms, including paralysis, allergic disorders, breathing abnormalities, and visual impairment, may hinder the recovery of these recipients.
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Cerebral Venous Sinus Thrombosis following COVID-19 Vaccination: Analysis of 552 Worldwide Cases. Vaccines (Basel) 2022; 10:vaccines10020232. [PMID: 35214690 PMCID: PMC8874972 DOI: 10.3390/vaccines10020232] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
To date, billions of vaccine doses have been administered to restrain the current COVID-19 pandemic worldwide. Rare side effects, including intravascular blood clots, were reported in the general population after vaccination. Among these, cerebral venous sinus thrombosis (CVST) has been considered the most serious one. To shed further light on such an event, we conducted a literature search for case descriptions of CVST in vaccinated people. Findings were analyzed with emphasis on demographic characteristics, type of vaccine, site of thrombosis, clinical and histopathological findings. From 258 potential articles published till September 2021, 41 studies were retrieved for a total of 552 patients. Of these, 492 patients (89.1%) had received AZD1222/Vaxzevria, 45 (8.2%) BNT162b2/CX-024414 Spikevax, 15 (2.7%) JNJ-78436735, and 2 (0.3%) Covishield vaccine. CVST occurred in 382 women and 170 men (mean aged 44 years), and the median timing from the shot was 9 days (range 2–45). Thrombi were predominantly seen in transverse (84%), sigmoid (66%), and/or superior sagittal (56%) sinuses. Brain injury (chiefly intracranial bleeding) occurred in 32% of cases. Of 426 patients with detailed clinical course, 63% were discharged in good clinical conditions, at times with variable neurological sequelae, whereas 37% deceased, largely due to brain injury. This narrative review confirmed CVST as a rare event after (adenoviral vector) COVID-19 vaccination, with a women/men rate ratio of 2.25. Though the pathogenesis of thrombosis is still under discussion, currently available histopathological findings likely indicate an underlying immune vasculitis.
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15
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Saleh M, Zimmermann J, Lehnen NC, Pötzsch B, Weller JM. Late-Onset Vaccine-Induced Immune Thombotic Thrombocytopenia (VITT) with Cerebral Venous Sinus Thrombosis. J Stroke Cerebrovasc Dis 2022; 31:106311. [PMID: 35093626 PMCID: PMC8799476 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives Vaccine-induced thrombotic thrombocytopenia (VITT) is a rare complication after adenoviral vector vaccination against COVID-19 reported up to 24 days after ChAdOx1 nCOV-19 (AZD1222) vaccination. This report describes a case with a significantly later onset of VITT with cerebral venous sinus thrombosis. Case description We report a 42-year-old woman presenting to the emergency department 53 days after AZD1222 vaccination with sudden onset sensory aphasia and an 18-day history of headache. Cranial computed tomography (CT) showed acute intracranial hemorrhage and CT venogram demonstrated thrombosis of the left vein of Labbé and transverse and sigmoid sinus. D-dimers were elevated and despite a normal platelet count, platelet-activating anti-PF4 antibody testing was positive, confirming the diagnosis of VITT. The patient was treated with intravenous immunoglobulins and argatroban, and was discharged without any neurological deficit on day 12. Conclusion Our report of VITT with symptom onset on day 35 and diagnosis of cerebral sinuous thrombosis on day 53 after AZD1222 vaccination significantly enhances the time window during which VITT may occur.
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Affiliation(s)
- Maruan Saleh
- Department of Neurology, University Hospital Bonn, Venusberg Campus 1, Bonn 53127, Germany
| | - Julian Zimmermann
- Department of Neurology, University Hospital Bonn, Venusberg Campus 1, Bonn 53127, Germany
| | - Nils C Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany; Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Johannes M Weller
- Department of Neurology, University Hospital Bonn, Venusberg Campus 1, Bonn 53127, Germany.
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16
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Ahmed SH, Shaikh TG, Waseem S, Qadir NA, Yousaf Z, Ullah I. Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review. Ann Med Surg (Lond) 2022; 73:102988. [PMID: 34745596 PMCID: PMC8556865 DOI: 10.1016/j.amsu.2021.102988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022] Open
Abstract
The novel coronavirus pandemic has taken a toll on the global healthcare systems and economy. Safety precautions, along with vaccination, are the most effective preventive measures. The global vaccination program against COVID-19 has dramatically reduced the number of deaths and cases. However, the incidence of thrombotic events and thrombocytopenia post-COVID-19 vaccination known as vaccine-induced thrombotic thrombocytopenia has raised safety concerns. This has led to an element of vaccine hesitancy. The exact mechanism for vaccine-induced thrombotic thrombocytopenia is unknown. Although the incidence of thrombosis associated with COVID-19 vaccination is low, it still requires attention, especially in older people, smokers, and people with preexisting comorbidities. This study aims to review the pathophysiology, diagnosis, and management of vaccine-induced thrombotic thrombocytopenia, to provide a concise and comprehensive update.
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Affiliation(s)
| | | | | | | | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
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17
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Al-Ali D, Elshafeey A, Mushannen M, Kawas H, Shafiq A, Mhaimeed N, Mhaimeed O, Mhaimeed N, Zeghlache R, Salameh M, Paul P, Homssi M, Mohammed I, Narangoli A, Yagan L, Khanjar B, Laws S, Elshazly MB, Zakaria D. Cardiovascular and haematological events post COVID-19 vaccination: A systematic review. J Cell Mol Med 2021; 26:636-653. [PMID: 34967105 PMCID: PMC8817142 DOI: 10.1111/jcmm.17137] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
Since COVID‐19 took a strong hold around the globe causing considerable morbidity and mortality, a lot of effort was dedicated to manufacturing effective vaccines against SARS‐CoV‐2. Many questions have since been raised surrounding the safety of the vaccines, and a lot of media attention to certain side effects. This caused a state of vaccine hesitancy that may prove problematic in the global effort to control the virus. This review was undertaken with the aim of putting together all the reported cardiovascular and haematological events post COVID‐19 vaccination in published literature and to suggest possible mechanisms to explain these rare phenomena.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lina Yagan
- Weill Cornell Medicine Qatar, Doha, Qatar
| | | | - Sa'ad Laws
- Weill Cornell Medicine Qatar, Doha, Qatar
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Lehmann F, Schenk LM, Bernstock JD, Bode C, Borger V, Gessler F, Güresir E, Hamed M, Potthoff AL, Putensen C, Schneider M, Zimmermann J, Vatter H, Schuss P, Hadjiathanasiou A. Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10245939. [PMID: 34945232 PMCID: PMC8708142 DOI: 10.3390/jcm10245939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/25/2023] Open
Abstract
The impact of dehydration at admission of patients with spontaneous intracerebral hemorrhage (ICH) on short-term mortality remains ambiguous due to scarce data. All of the consecutive patients with spontaneous ICH, who were referred to our neurovascular center in 2018/19, were assessed for hydration status on admission. Dehydration was defined by a blood urea-to-creatinine ratio > 80. In a cohort of 249 patients, 76 patients (31%) were dehydrated at the time of admission. The following factors were significantly and independently associated with increased 30-day mortality in multivariate analysis: “signs of cerebral herniation” (p = 0.008), “initial midline shift > 5 mm” (p < 0.001), “ICH score > 3” (p = 0.007), and “admission dehydration status” (p = 0.007). The results of the present study suggest that an admission dehydration status might constitute a significant and independent predictor of short-term mortality in patients with spontaneous ICH.
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Affiliation(s)
- Felix Lehmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
- Correspondence: ; Tel.: +49-228-287-14119
| | - Lorena M. Schenk
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Christian Bode
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Rostock, 18055 Rostock, Germany;
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Julian Zimmermann
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Alexis Hadjiathanasiou
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
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19
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Argatroban/immunostimulants. REACTIONS WEEKLY 2021. [PMCID: PMC8616966 DOI: 10.1007/s40278-021-06015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Finsterer J, Redzic Z. Symptomatic peduncular, cavernous bleeding following SARS-CoV-2 vaccination induced immune thrombocytopenia. BRAIN HEMORRHAGES 2021; 2:169-171. [PMID: 34549178 PMCID: PMC8443534 DOI: 10.1016/j.hest.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Therapy-responsive immune thrombocytopenia and anemia shortly after the second dose of an mRNA-based SARS-CoV-2 vaccine, which was complicated by symptomatic bleeding within a pre-existing brainstem cavernoma, has not been reported. The patient is a 68yo male who experienced gait disturbance and hypoesthesia of the left face and left upper extremity two days after the second dose of the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Tozinameran). Clinical neurologic exam revealed hypoesthesia of the left face and the left upper extremity and ataxic gait. Blood tests revealed macrocytic anemia and marked thrombocytopenia, interpreted as vaccination induced immune thrombocytopenia (ITP). Cerebral MRI revealed subacute bleeding within a pre-existing solitary cavernoma located in the right cerebellar peduncle. With proceeding resorption of the bleeding, symptoms gradually regressed. This case shows that SARS-CoV-2 vaccinations may be followed by ITP and bleeding in pre-existing vascular malformations. In order to avoid cavernoma bleeding in patients with SARS-CoV-2 vaccination associated ITP and thrombocyte dysfunction, urgent treatment of ITP is warranted. In order to identify patients at risk for experiencing SARS-CoV-2 vaccination induced ITP, further studies are urgently warranted.
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Affiliation(s)
- Josef Finsterer
- Neurological Dpt., Klinik Landstrasse, Messerli Institute, Vienna, Austria
| | - Zinka Redzic
- Radiological Dpt., Klinik Landstrasse, Vienna, Austria
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21
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Datta P, Zhang F, Dordick JS, Linhardt RJ. Platelet factor 4 polyanion immune complexes: heparin induced thrombocytopenia and vaccine-induced immune thrombotic thrombocytopenia. Thromb J 2021; 19:66. [PMID: 34526009 PMCID: PMC8443112 DOI: 10.1186/s12959-021-00318-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This is a review article on heparin-induced thrombocytopenia, an adverse effect of heparin therapy, and vaccine-induced immune thrombotic thrombocytopenia, occurring in some patients administered certain coronavirus vaccines. MAIN BODY/TEXT Immune-mediated thrombocytopenia occurs when specific antibodies bind to platelet factor 4 /heparin complexes. Platelet factor 4 is a naturally occurring chemokine, and under certain conditions, may complex with negatively charged molecules and polyanions, including heparin. The antibody-platelet factor 4/heparin complex may lead to platelet activation, accompanied by other cascading reactions, resulting in cerebral sinus thrombosis, deep vein thrombosis, lower limb arterial thrombosis, myocardial infarction, pulmonary embolism, skin necrosis, and thrombotic stroke. If untreated, heparin-induced thrombocytopenia can be life threatening. In parallel, rare incidents of spontaneous vaccine-induced immune thrombotic thrombocytopenia can also occur in some patients administered certain coronavirus vaccines. The role of platelet factor 4 in vaccine-induced thrombosis with thrombocytopenia syndrome further reinforces the importance the platelet factor 4/polyanion immune complexes and the complications that this might pose to susceptible individuals. These findings demonstrate, how auxiliary factors can complicate heparin therapy and drug development. An increasing interest in biomanufacturing heparins from non-animal sources has driven a growing interest in understanding the biology of immune-mediated heparin-induced thrombocytopenia, and therefore, the development of safe and effective biosynthetic heparins. SHORT CONCLUSION In conclusion, these findings further reinforce the importance of the binding of platelet factor 4 with known and unknown polyanions, and the complications that these might pose to susceptible patients. In parallel, these findings also demonstrate how auxiliary factors can complicate the heparin drug development.
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Affiliation(s)
- Payel Datta
- Heparin Applied Research Center, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Fuming Zhang
- Heparin Applied Research Center, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Jonathan S Dordick
- Heparin Applied Research Center, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Robert J Linhardt
- Heparin Applied Research Center, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA.
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22
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Lundstrom K, Barh D, Uhal BD, Takayama K, Aljabali AAA, Abd El-Aziz TM, Lal A, Redwan EM, Adadi P, Chauhan G, Sherchan SP, Azad GK, Rezaei N, Serrano-Aroca Á, Bazan NG, Hassan SS, Panda PK, Pal Choudhury P, Pizzol D, Kandimalla R, Baetas-da-Cruz W, Mishra YK, Palu G, Brufsky AM, Tambuwala MM, Uversky VN. COVID-19 Vaccines and Thrombosis-Roadblock or Dead-End Street? Biomolecules 2021; 11:1020. [PMID: 34356644 PMCID: PMC8301964 DOI: 10.3390/biom11071020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022] Open
Abstract
Two adenovirus-based vaccines, ChAdOx1 nCoV-19 and Ad26.COV2.S, and two mRNA-based vaccines, BNT162b2 and mRNA.1273, have been approved by the European Medicines Agency (EMA), and are invaluable in preventing and reducing the incidence of coronavirus disease-2019 (COVID-19). Recent reports have pointed to thrombosis with associated thrombocytopenia as an adverse effect occurring at a low frequency in some individuals after vaccination. The causes of such events may be related to SARS-CoV-2 spike protein interactions with different C-type lectin receptors, heparan sulfate proteoglycans (HSPGs) and the CD147 receptor, or to different soluble splice variants of the spike protein, adenovirus vector interactions with the CD46 receptor or platelet factor 4 antibodies. Similar findings have been reported for several viral diseases after vaccine administration. In addition, immunological mechanisms elicited by viral vectors related to cellular delivery could play a relevant role in individuals with certain genetic backgrounds. Although rare, the potential COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) requires immediate validation, especially in risk groups, such as the elderly, chronic smokers, and individuals with pre-existing incidences of thrombocytopenia; and if necessary, a reformulation of existing vaccines.
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Affiliation(s)
| | - Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Purba Medinipur 721172, India
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Bruce D. Uhal
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA;
| | - Kazuo Takayama
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8397, Japan;
| | - Alaa A. A. Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan;
| | - Tarek Mohamed Abd El-Aziz
- Zoology Department, Faculty of Science, Minia University, El-Minia 61519, Egypt;
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, USA;
| | - Elrashdy M. Redwan
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Parise Adadi
- Department of Food Science, University of Otago, Dunedin 9054, New Zealand;
| | - Gaurav Chauhan
- School of Engineering and Sciences, Tecnológico de Monterrey, Av. Eugenio Garza Sada 2501 Sur, Monterrey 64849, Mexico;
| | - Samendra P. Sherchan
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA 70112, USA;
| | | | - Nima Rezaei
- Research Center for Immunodeficiency, Children’s Medical Center, Tehran University of Medical Sciences, Tehran 1416753955, Iran;
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), 17177 Stockholm, Sweden
| | - Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, c/Guillem de Castro 94, 46001 Valencia, Spain;
| | - Nicolas G. Bazan
- Neuroscience Center of Excellence, School of Medicine, LSU Health New Orleans, New Orleans, LA 70112, USA;
| | - Sk Sarif Hassan
- Department of Mathematics, Pingla Thana Mahavidyalaya, Maligram 721140, India;
| | - Pritam Kumar Panda
- Condensed Matter Theory Group, Materials Theory Division, Department of Physics and Astronomy, Uppsala University, Box 516, 75120 Uppsala, Sweden;
| | | | - Damiano Pizzol
- Italian Agency for Development Cooperation—Khartoum, Sudan Street 33, Al Amarat 11111, Sudan;
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Technology, Uppal Road, Tarnaka, Hyderabad 500007, India;
- Department of Biochemistry, Kakatiya Medical College, Warangal 506007, India
| | - Wagner Baetas-da-Cruz
- Translational Laboratory in Molecular Physiology, Centre for Experimental Surgery, College of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil;
| | - Yogendra Kumar Mishra
- Mads Clausen Institute, University of Southern Denmark, NanoSYD, Alsion 2, 6400 Sønderborg, Denmark;
| | - Giorgio Palu
- Department of Molecular Medicine, University of Padova, 35122 Padova, PD, Italy;
| | - Adam M. Brufsky
- UPMC Hillman Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Murtaza M. Tambuwala
- School of Pharmacy and Pharmaceutical Science, Ulster University, Coleraine BT52 1SA, UK
| | - Vladimir N. Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer’s Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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