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Abstract Details

Vaccine-induced immune thrombotic thrombocytopenia: an emerging disease during the COVID-19 pandemic
General Neurology
P14 - Poster Session 14 (11:45 AM-12:45 PM)
12-006

35-year-old was admitted to the emergency in late April 2021 with a headache and a single episode. Had a history of COVID-19 infection in January 2021, gastroplasty in 2018, and received her first dose of ChAdOx1 nCoV-19 vaccine 8 days prior. Besides the worsening headache (rating 7/10), she developed severe thrombocytopenia (platelets 31,000/mm3) and was then hospitalized. Head CT revealed no alterations. Four days after, there was no clinical or laboratory evidence of thrombosis (D-dimer 16.56ng/ml). The initial diagnosis was immune thrombocytopenic purpura and corticosteroids as treatment. A month after, the patient presented with a sudden onset of headache and decreased consciousness, platelet count 54,000/mm3, normal PT and PTT, and GCS of 12. CT revealed left fronto-temporo-parietal intraparenchymal hemorrhagic with midline shift and intraventricular hemorrhage. CT angiogram revealed thrombosis of the left sigmoid vein, left transverse vein, left jugular bulb, and superior sagittal sinus. A left decompressive craniectomy with extensive hematoma drainage was performed. After surgical treatment, immunoglobulin is administered due to the possibility of vaccine-induced immune thrombotic thrombocytopenia (VITT), along with fondaparinux anticoagulation. Anti-heparin antibody was elevated 218 U/ml (normal < 1.0 U/ml). She underwent mechanical thrombectomy with stent placement under aspiration, resulting in recanalization of the transverse venous sinus. Anticoagulation was switched to apixaban, and plasmapheresis was scheduled two days after the procedure due to severe acute anemia and neurological deterioration. On the same day as the procedure, CT angiography revealed occlusion of the dural venous sinuses. Despite treatment with methylprednisolone, anti-platelet aggregation, and rituximab, brain death occurred 3 months after the initial presentation.

To describe a case of vaccine-induced thrombotic thrombocytopenia
NA
NA
The COVID-19 vaccine can bring complications. We still need explanations in the literature.
Authors/Disclosures
Naiade Couto, MD (Naiade Couto)
PRESENTER
Dr. Couto has nothing to disclose.
Raimundo Marcial de Brito Neto, Sr., MD (Hospital Universitario Antonio Pedro) Dr. Brito Neto has nothing to disclose.
Gabriel Da Silva Avellar, MD (Hospital Universitario Pedro Ernesto) No disclosure on file
Raimundo Marcial de Brito Neto, Sr., MD (Hospital Universitario Antonio Pedro) Dr. Brito Neto has nothing to disclose.
Jonadab Dos Santos Silva (Icahn School of Medicine at Mount Sinai) Mr. Dos Santos Silva has nothing to disclose.