Guidance Issued for Managing CVST After COVID-19 Vaccination
CVST with thrombocytopenia reported after COVID-19 vaccine with adenoviral vector; management similar to heparin-induced thrombocytopenia
TUESDAY, May 11, 2021 (HealthDay News) -- In a report from the American Heart Association/American Stroke Association Stroke Council Leadership, published online April 29 in Stroke, recommendations are presented for the management of cerebral venous sinus thrombosis (CVST) with vaccine-induced immune thrombic thrombocytopenia after receipt of a COVID-19 vaccine containing adenoviral vectors.
Karen L. Furie, M.D., M.P.H., from The Warren Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues examined the apparent association between adenovirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations and CVST with vaccine-induced immune thrombotic thrombocytopenia.
According to the report, infection with SARS-CoV-2 is a risk factor for CVST, with incidence of 39.0 per million people after COVID-19 compared with 0.41 per million in the pre-COVID-19 epoch. Among individuals who experienced CVST after receiving the Ad26.COV2.S (Janssen) adenovirus-based SARS-CoV-2 vaccine in the United States, headache was the most common symptom, which occurred six to 13 days after vaccine receipt. Similar reports from Europe describe thrombocytopenia and venous thrombosis after the AstraZeneca ChAdOx1 nCoV-19 vaccine. Magnetic resonance imaging or computed tomography with venogram can detect CVST in suspected cases. Acute management should follow that of heparin-induced thrombocytopenia. Heparin products should not be given; alternative anticoagulants to heparin should be given, or a direct oral anticoagulant should be given at therapeutic dose intensity. Anticoagulation is recommended, even in the presence of secondary intracranial hemorrhage, while platelet transfusion should be avoided. Most patients can be transitioned to an oral anticoagulant if there are no contraindications after full platelet recovery.
"We will need data and robust research on the people who did not develop blood clots after the vaccine, too, so that we can fully understand the molecular and cellular mechanisms underlying CVST related to COVID-19 infection or after vaccination," Furie said in a statement.
One author disclosed financial ties to UpToDate.