Successful management of vaccine-induced immune thrombotic thrombocytopenia-related cerebral sinus venous thrombosis after ChAdOx1 nCov-19 vaccination.

Very recently, unusual thrombotic events in combination with severe thrombocytopenia have been reported 1–2 weeks following SARS-CoV-2 vaccination with ChAdOx1 nCov-19 (AstraZeneca). This condition, termed VITT (vaccine-induced immune thrombotic thrombocytopenia), has been related to high risk of fatal outcome with both ischaemic and haemorrhagic complications.1 2 Optimal treatment strategies still need to be elucidated—especially in case of cerebral sinus venous thrombosis (CSVT) with associated brain haemorrhage as the underlying thrombotic event. We here report our clinical experience with two young women diagnosed with VITT-associated CSVT, treated with high-dose intravenous immunoglobulins (IVIGs), corticosteroids and argatroban in the hyperacute phase, followed by dabigatran resulting in excellent outcome. A 39-year-old woman with an unremarkable medical history was admitted with severe holocephalic headache since 2 days. Eight days earlier, she had received the first vaccination with ChAdOx1 nCov-19 (AstraZeneca). Physical and neurological examination was normal. Laboratory investigations revealed moderate thrombocytopenia (84×109/L) and significantly elevated D-dimer (14.2 mg/L; normal <0.5 mg/L). Fibrinogen and other routine parameters were normal (table 1). Brain CT including venography was unremarkable as were CT pulmonary angiography and compression ultrasound of both legs. Coincidentally, the patient had contact with a COVID-19-positive person a few days after vaccination and SARS-CoV-2 reverse transcription PCR (RT-PCR) on admission was positive with cycle threshold value 26 on a nasopharyngeal swab. Prophylactic treatment with danaparoid 750 IU two times per day subcutaneously and intravenous dexamethasone 40 mg were started. While the …