Brain, behavior, and immunity
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Brain Behav. Immun. · Jul 2021
Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination - a report of two UK cases.
Recent reports have highlighted rare, and sometimes fatal, cases of cerebral venous sinus thrombosis (CVST) and thrombocytopenia following the Vaxzevria vaccine. An underlying immunological mechanism similar to that of spontaneous heparin-induced thrombocytopenia (HIT) is suspected, with the identification of antibodies to platelet factor-4 (PF4), but without previous heparin exposure. This unusual mechanism has significant implications for the management approach used, which differs from usual treatment of CVST. ⋯ However, some cases have proved fatal. Itis critical that clinicians arealerted to the emergence of such eventstofacilitate appropriate management. Patients presenting with CVST features and thrombocytopenia post-vaccination should undergo PF4 antibody testing and be managed in a similar fashion to HIT, in particular avoiding heparin and platelet transfusions.