Cases of clots in large arteries causing stroke after COVID-19 vaccination were first reported.

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Clots in the arteries (arterial thrombosis) are the most common cause of stroke (ischemic stroke) and have been reported in detail for the first time in young adults who received the Oxford-AstraZeneca COVID-19 vaccine in a letter from specialists in UK stroke published online at Journal of Neurosurgery and Neurology Psychiatry.

Although cases of have been previously reported after administration of the COVID-19 Oxford-AstraZeneca vaccine, which have affected veins and more specifically brain veins (cerebral venous sinuses).

People who have experienced this unusual form of stroke (cerebral venous sinus thrombosis) have also had a low platelet count (thrombocytopenia) and antibodies against platelet factor 4 (PF4), proteins that help form clots.

The most common form of stroke, where blood clots occur supplying blood to the brain (ischemic stroke) has not previously been described as the characteristic presenting thrombosis after administration of the Oxford-AstraZeneca vaccine, but the authors of this letter report three cases in detail.

In all cases, ischemic stroke was associated with blockages of large arteries (both carotid and ) and two patients also had venous thrombosis affecting the portal and cerebral venous system. All three also had an extremely low platelet count, confirmed anti-PF4 antibodies, and increased D-dimer (also related to coagulation).

The first patient, a woman in her 30s, experienced an intermittent headache on her right side and around her eyes six days after the vaccine. Five days later she woke up feeling sleepy and weak on her left face, arm and leg. The image revealed a blocked right cerebral artery with cerebral infarction and blood clots in right portal vein thrombosis. He underwent brain surgery to reduce the pressure on his skull, remove the plasma and replace it, and received the anticoagulant drug fondaparinux, but unfortunately died.

The second patient, a woman in her 30s, presented with headache, confusion, weakness in her left arm, and loss of vision in her left side 12 days after receiving the vaccine. The image showed blockages in several vessels, including the carotid arteries (the main blood supply to the hemispheres of the brain), the arteries that supply the heart and lungs (pulmonary embolism), and the left transverse sinus (one of the cerebral venous sinuses). . Platelet count increased after plasma and intravenous removal and replacement of corticosteroids. He was then given fondaparinux and improved.

The third patient, a man in his 40s, presented 3 weeks after receiving the vaccine with problems speaking and understanding language (dysphasia). The image showed a clot in the left middle cerebral artery, but there was no evidence of clots in the cerebral venous sinuses. He received a transfusion of platelets and plasma, and fondaparinux, and remains stable.

The lead author, Professor David Werring, of the Stroke Research Center at UCL Queen Square Institute of Neurology, says the cases described suggest that in addition to cerebral venous thrombosis, thrombotic immune thrombocytopenia Vaccine-induced (TVV) can also cause clots to block the arteries that supply the brain, causing ischemic stroke.

“Young patients with ischemic stroke after receiving the [Oxford-AstraZeneca] the vaccine should be evaluated urgently for VITT with laboratory tests (including platelet count, D-dimers, fibrinogens, and anti-PF4 antibodies) and managed by a multidisciplinary team (hematology, neurology, stroke, neurosurgery, neuroradiology) to quickly access treatments that include intravenous immunoglobulin, methylprednisolone, plasmapheresis, and non-heparinized anticoagulants, such as fondaparinux, argatroban, or direct oral anticoagulants, ”the authors say.

In a related comment, Professor Hugh Markus, of the Department of Clinical Neuroscience at Cambridge University, writes: “This report emphasizes that immunity-mediated coagulopathy can also cause arterial thrombosis, including ischemic thrombosis. , although venous thrombosis and, above all, cerebral venous sinus they seem more frequent “.

He adds: “During the current period of vaccination against COVID a high rate of suspicion is required to identify post-vaccination thrombotic episodes. However, it is important to remember that these side effects are rare and much less common than both cerebral. i associated with COVID-19 infection itself.


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More information:
Ischemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombocytopenia Journal of Neurosurgery and Neurology Psychiatry DOI: 10.1136 / jnnp-2021-326984

Comment: Ischemic stroke can follow vaccination against COVID-19, but is much more common with COVID-19 infection itself. Journal of Neurosurgery and Neurology Psychiatry, DOI: 10.1136 / jnnp-2021-327057

Citation: First reported cases of clots in large arteries causing stroke after vaccination against COVID-19 (2021, May 25) recovered on May 25, 2021 at https://medicalxpress.com/news/2021-05-cases -clots-large-arteries-covid -.html

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