Clinical Review of Cerebral Venous Thrombosis in the Context of COVID-19 Vaccinations: Evaluation, Management, and Scientific Questions

20 Pages Posted: 26 May 2021

See all articles by Kiran T. Thakur

Kiran T. Thakur

Department of Neurology - Columbia University Irving Medical Center

Arina Tamborska

University of Liverpool - Institute of Infection and Global Health

Greta K. Wood

University of Liverpool - Institute of Infection and Global Health

Emily N. McNeill

Columbia University - New York Presbyterian

David Roh

Columbia University - Division of Hospital and Critical Care Neurology

Imo Akpan

Columbia University - New York Presbyterian

Eliza C. Miller

Columbia University - New York Presbyterian

Alyssa Bautista

Columbia University - New York Presbyterian

Jan Claassen

Columbia University - Division of Hospital and Critical Care Neurology

Carla Y. Kim

Cornell University - Department of Neurology

Alla Guekht

Moscow Research and Clinical Center for Neuropsychiatry

Carlos A. Pardo-Villamizar

Johns Hopkins University - School of Medicine

Olajide Williams

Columbia University - New York Presbyterian

David García-Azorín

University of Valladolid - Department of Neurology

Kameshwar Prasad

Rajendra Institute of Medical Sciences

Erich Schmutzhard

Medical University of Innsbruck

Benedict D. Michael

Harvard University - Massachusetts General Hospital

Sherry Hsiang-Yi Chou

University of Pittsburgh - Departments of Critical Care Medicine, Neurology, and Neurosurgery

Andrea S. Winkler

Technical University of Munich - Center for Global Health

Tom Solomon

University of Liverpool - Institute of Infection, Veterinary and Ecological Sciences

Mitchell S.V. Elkind

Columbia University Medical Center, Department of Neurology

Date Written: May 7, 2021

Abstract

Background: Vaccine induced immune medicated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2.S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers.

Methods: A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists.

Findings: Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation.

Interpretation: There are many unanswered questions regarding cases of CVT, possibly in association with VITT. Public health specialists should explore ways to enhance public and professional education, surveillance, and reporting of this syndrome to reduce its impact on health and global vaccination efforts.

Funding: None

Note: Funding Statement: None.

Declaration of Interests: Authors have declared their conflicts of interest within the manuscript. Corresponding author: KTT is a member of the World Health Organization (WHO) working group on clinical guidance of VITT in the context of COVID-19 vaccinations, reports funding from the National Institute of Health (NIH) and Center for Disease Control and Prevention (CDC) on neurological conditions in the context of COVID-19 and COVID-19 vaccinations.

Keywords: Cerebral Venous Thrombosis, Adenovirus Vaccine, COVID-19, Anticoagulation, Thrombocytopenia

Suggested Citation

Thakur, Kiran T. and Tamborska, Arina and Wood, Greta K. and N. McNeill, Emily and Roh, David and Akpan, Imo and C. Miler, Eliza and Bautista, Alyssa and Claassen, Jan and Y. Kim, Carla and Guekht, Alla and A. Pardo-Villamizar, Carlos and Williams, Olajide and García-Azorín, David and Prasad, Kameshwar and Schmutzhard, Erich and Michael, Benedict D. and Chou, Sherry Hsiang-Yi and Winkler, Andrea S. and Solomon, Tom and Elkind, Mitchell S.V., Clinical Review of Cerebral Venous Thrombosis in the Context of COVID-19 Vaccinations: Evaluation, Management, and Scientific Questions (May 7, 2021). Available at SSRN: https://ssrn.com/abstract=3844148 or http://dx.doi.org/10.2139/ssrn.3844148

Kiran T. Thakur (Contact Author)

Department of Neurology - Columbia University Irving Medical Center ( email )

Arina Tamborska

University of Liverpool - Institute of Infection and Global Health

8 West Derby Street
Liverpool, L69 7BE
United Kingdom

Greta K. Wood

University of Liverpool - Institute of Infection and Global Health

8 West Derby Street
Liverpool, L69 7BE
United Kingdom

Emily N. McNeill

Columbia University - New York Presbyterian

United States

David Roh

Columbia University - Division of Hospital and Critical Care Neurology ( email )

Imo Akpan

Columbia University - New York Presbyterian ( email )

United States

Eliza C. Miler

Columbia University - New York Presbyterian ( email )

United States

Alyssa Bautista

Columbia University - New York Presbyterian ( email )

United States

Jan Claassen

Columbia University - Division of Hospital and Critical Care Neurology ( email )

Carla Y. Kim

Cornell University - Department of Neurology ( email )

New York, NY
United States

Alla Guekht

Moscow Research and Clinical Center for Neuropsychiatry ( email )

United States

Carlos A. Pardo-Villamizar

Johns Hopkins University - School of Medicine ( email )

733 North Broadway
Suite G-49
Baltimore, MD 21205-2196
United States

Olajide Williams

Columbia University - New York Presbyterian ( email )

United States

David García-Azorín

University of Valladolid - Department of Neurology ( email )

Avenida Ramón y Cajal n° 3
47003 Valladolid
Spain
+34983420000 Ext. 87289 (Phone)
+34 665872228 (Fax)

Kameshwar Prasad

Rajendra Institute of Medical Sciences ( email )

Bariatu
Ranchi, Jharkhand 834009
India

Erich Schmutzhard

Medical University of Innsbruck ( email )

Innrain 52
Christoph-Probst-Platz
Innsbruck, 6020
Austria

Benedict D. Michael

Harvard University - Massachusetts General Hospital

55 Fruit Street Boston
Boston, MA 02114
United States

Sherry Hsiang-Yi Chou

University of Pittsburgh - Departments of Critical Care Medicine, Neurology, and Neurosurgery ( email )

Pittsburgh, PA
United States

Andrea S. Winkler

Technical University of Munich - Center for Global Health

Arcisstrasse 21
Munich, DE 80333
Germany

Tom Solomon

University of Liverpool - Institute of Infection, Veterinary and Ecological Sciences ( email )

Mitchell S.V. Elkind

Columbia University Medical Center, Department of Neurology

College of Physicians and Surgeons
630 West 168th Street, 3rd Floor, Suite 3-470
New York, NY 10032-3784
United States

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