Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

Kiran T Thakur; Arina Tamborska; Greta K Wood; Emily McNeill; David Roh; Imo J Akpan; Eliza C Miller; Alyssa Bautista; Jan Claassen; Carla Y Kim; Alla Guekht; Carlos A Pardo; Olajide Williams; David García-Azorín; Kameshwar Prasad; Erich Schmutzhard; Benedict D Michael; Sherry H-Y Chou; Andrea S Winkler; Tom Solomon; Mitchell S Elkind

doi:10.1016/j.jns.2021.117532

Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

J Neurol Sci. 2021 Aug 15:427:117532. doi: 10.1016/j.jns.2021.117532. Epub 2021 Jun 5.

Authors

Kiran T Thakur¹, Arina Tamborska², Greta K Wood³, Emily McNeill⁴, David Roh⁴, Imo J Akpan⁵, Eliza C Miller⁴, Alyssa Bautista⁴, Jan Claassen⁴, Carla Y Kim⁴, Alla Guekht⁶, Carlos A Pardo⁷, Olajide Williams⁴, David García-Azorín⁸, Kameshwar Prasad⁹, Erich Schmutzhard¹⁰, Benedict D Michael¹¹, Sherry H-Y Chou¹², Andrea S Winkler¹³, Tom Solomon¹⁴, Mitchell S Elkind⁴

Affiliations

¹ Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA. Electronic address: ktt2115@cumc.columbia.edu.
² National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK.
³ Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK.
⁴ Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
⁵ Department of Hematology/Oncology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
⁶ Moscow Research and Clinical Center for Neuropsychiatry & Russian National Research Medical University, Moscow, Russia.
⁷ Divisions of Neuroimmunology and Neuroinfectious Disorders & Advanced Clinical Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁹ Rajendra Institute of Medical Sciences, Ranchi 834009, Jharkhand, India.
¹⁰ Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria.
¹¹ Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital/Harvard University, Boston, MA, USA.
¹² Department of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹³ Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
¹⁴ National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.

Abstract

Background: Vaccine induced immune mediated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers.

Methods: A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists.

Findings: Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation.

Keywords: COVID-19; Cerebral venous thrombosis; Vaccination.

Publication types

Review

MeSH terms

COVID-19 Vaccines
COVID-19*
ChAdOx1 nCoV-19
Humans
SARS-CoV-2
Vaccination / adverse effects
Venous Thrombosis* / therapy

Substances

COVID-19 Vaccines
ChAdOx1 nCoV-19

Abstract

Publication types

MeSH terms

Substances

Grants and funding