Diffuse prothrombotic syndrome after ChAdOx1 nCoV-19 vaccine administration: a case report.
Acute limb ischemia
Anti-COVID-19 vaccine
Case report
Side effects
Vaccine-induced immune thrombotic thrombocytopenia
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
06 Oct 2021
06 Oct 2021
Historique:
received:
14
07
2021
accepted:
30
08
2021
entrez:
7
10
2021
pubmed:
8
10
2021
medline:
9
10
2021
Statut:
epublish
Résumé
Vaccine-induced immune thrombotic thrombocytopenia is emerging as one of the most relevant side effects of adenoviral-based vaccines against coronavirus disease 2019. Given the novelty of this disease, the medical community is seeking new evidence and clinical experiences on the management of these patients. In this article, we describe the case of a 73-year-old Caucasian woman who presented with diffuse prothrombotic syndrome, both in the arterial and venous districts, following the first dose administration of ChAdOx1 CoV-19 vaccine. The main thrombotic sites included the brain, with both a cortical ischemic lesion and thromboses of the left transverse and sigmoid sinuses and the lower limbs, with deep venous thrombosis accompanied by subsegmental pulmonary thromboembolism. The deep venous thrombosis progressively evolved into acute limb ischemia, requiring surgical intervention with thromboendoarterectomy. Anticoagulation was maintained throughout the whole hospitalization period and continued in the outpatient setting using vitamin K antagonists for a recommended period of 6 months. This case describes the management of vaccine-induced immune thrombotic thrombocytopenia in a complicated clinical scenario, including multisite arterial and venous thromboses. Given the complexity of the patient presentation, this case may implement the comprehension of the mechanisms and clinical features of this disease; it also provides a picture of the challenges related to the management, often requiring a multidisciplinary approach.
Sections du résumé
BACKGROUND
BACKGROUND
Vaccine-induced immune thrombotic thrombocytopenia is emerging as one of the most relevant side effects of adenoviral-based vaccines against coronavirus disease 2019. Given the novelty of this disease, the medical community is seeking new evidence and clinical experiences on the management of these patients.
CASE PRESENTATION
METHODS
In this article, we describe the case of a 73-year-old Caucasian woman who presented with diffuse prothrombotic syndrome, both in the arterial and venous districts, following the first dose administration of ChAdOx1 CoV-19 vaccine. The main thrombotic sites included the brain, with both a cortical ischemic lesion and thromboses of the left transverse and sigmoid sinuses and the lower limbs, with deep venous thrombosis accompanied by subsegmental pulmonary thromboembolism. The deep venous thrombosis progressively evolved into acute limb ischemia, requiring surgical intervention with thromboendoarterectomy. Anticoagulation was maintained throughout the whole hospitalization period and continued in the outpatient setting using vitamin K antagonists for a recommended period of 6 months.
CONCLUSIONS
CONCLUSIONS
This case describes the management of vaccine-induced immune thrombotic thrombocytopenia in a complicated clinical scenario, including multisite arterial and venous thromboses. Given the complexity of the patient presentation, this case may implement the comprehension of the mechanisms and clinical features of this disease; it also provides a picture of the challenges related to the management, often requiring a multidisciplinary approach.
Identifiants
pubmed: 34615534
doi: 10.1186/s13256-021-03083-y
pii: 10.1186/s13256-021-03083-y
pmc: PMC8493358
doi:
Substances chimiques
COVID-19 Vaccines
0
Vaccines
0
ChAdOx1 nCoV-19
B5S3K2V0G8
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
496Informations de copyright
© 2021. The Author(s).
Références
Intern Emerg Med. 2021 Aug;16(5):1113-1119
pubmed: 34191218
N Engl J Med. 2021 Jun 10;384(23):2202-2211
pubmed: 33861525
Blood Transfus. 2021 Apr 15;:
pubmed: 33871350
Ann Pharmacother. 2021 Feb;55(2):198-215
pubmed: 32693627
N Engl J Med. 2021 Jun 3;384(22):2124-2130
pubmed: 33835768
N Engl J Med. 2021 Aug 19;385(8):720-728
pubmed: 34107198
N Engl J Med. 2021 Jun 3;384(22):2092-2101
pubmed: 33835769