Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

Kiran T. Thakur; Arina Tamborska; Greta K. Wood; Emily McNeill; David Roh; Imo J. Akpan; Eliza C. Miller; Alyssa Bautista; Jan Claassen; Carla Y. Kim; Alla Guekht; Carlos A. Pardo; Olajide Williams; David García-Azorín; Kameshwar Prasad; Erich Schmutzhard; Benedict D. Michael; Sherry H.Y. Chou; Andrea S. Winkler; Tom Solomon; Mitchell S. Elkind

doi:10.1016/j.jns.2021.117532

Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

Kiran T. Thakur, Arina Tamborska, Greta K. Wood, Emily McNeill, David Roh, Imo J. Akpan, Eliza C. Miller, Alyssa Bautista, Jan Claassen, Carla Y. Kim, Alla Guekht, Carlos A. Pardo, Olajide Williams, David García-Azorín, Kameshwar Prasad, Erich Schmutzhard, Benedict D. Michael, Sherry H.Y. Chou, Andrea S. Winkler, Tom SolomonMitchell S. Elkind

School of Medicine

Research output: Contribution to journal › Review article › peer-review

Abstract

Background: Vaccine induced immune mediated 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.

Original language	English (US)
Article number	117532
Journal	Journal of the Neurological Sciences
Volume	427
DOIs	https://doi.org/10.1016/j.jns.2021.117532
State	Published - Aug 15 2021

Keywords

COVID-19
Cerebral venous thrombosis
Vaccination

ASJC Scopus subject areas

Neurology
Clinical Neurology

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10.1016/j.jns.2021.117532

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Thakur, K. T., Tamborska, A., Wood, G. K., McNeill, E., Roh, D., Akpan, I. J., Miller, E. C., Bautista, A., Claassen, J., Kim, C. Y., Guekht, A., Pardo, C. A., Williams, O., García-Azorín, D., Prasad, K., Schmutzhard, E., Michael, B. D., Chou, S. H. Y., Winkler, A. S., ... Elkind, M. S. (2021). Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions. Journal of the Neurological Sciences, 427, Article 117532. https://doi.org/10.1016/j.jns.2021.117532

Thakur, KT, Tamborska, A, Wood, GK, McNeill, E, Roh, D, Akpan, IJ, Miller, EC, Bautista, A, Claassen, J, Kim, CY, Guekht, A, Pardo, CA, Williams, O, García-Azorín, D, Prasad, K, Schmutzhard, E, Michael, BD, Chou, SHY, Winkler, AS, Solomon, T & Elkind, MS 2021, 'Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions', Journal of the Neurological Sciences, vol. 427, 117532. https://doi.org/10.1016/j.jns.2021.117532

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title = "Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions",

abstract = "Background: Vaccine induced immune mediated 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.",

keywords = "COVID-19, Cerebral venous thrombosis, Vaccination",

author = "Thakur, {Kiran T.} and Arina Tamborska and Wood, {Greta K.} and Emily McNeill and David Roh and Akpan, {Imo J.} and Miller, {Eliza C.} and Alyssa Bautista and Jan Claassen and Kim, {Carla Y.} and Alla Guekht and Pardo, {Carlos A.} and Olajide Williams and David Garc{\'i}a-Azor{\'i}n and Kameshwar Prasad and Erich Schmutzhard and Michael, {Benedict D.} and Chou, {Sherry H.Y.} and Winkler, {Andrea S.} and Tom Solomon and Elkind, {Mitchell S.}",

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year = "2021",

month = aug,

day = "15",

doi = "10.1016/j.jns.2021.117532",

language = "English (US)",

volume = "427",

journal = "Journal of the Neurological Sciences",

issn = "0022-510X",

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TY - JOUR

T1 - Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations

T2 - Evaluation, management, and scientific questions

AU - Thakur, Kiran T.

AU - Tamborska, Arina

AU - Wood, Greta K.

AU - McNeill, Emily

AU - Roh, David

AU - Akpan, Imo J.

AU - Miller, Eliza C.

AU - Bautista, Alyssa

AU - Claassen, Jan

AU - Kim, Carla Y.

AU - Guekht, Alla

AU - Pardo, Carlos A.

AU - Williams, Olajide

AU - García-Azorín, David

AU - Prasad, Kameshwar

AU - Schmutzhard, Erich

AU - Michael, Benedict D.

AU - Chou, Sherry H.Y.

AU - Winkler, Andrea S.

AU - Solomon, Tom

AU - Elkind, Mitchell S.

PY - 2021/8/15

Y1 - 2021/8/15

N2 - Background: Vaccine induced immune mediated 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.

AB - Background: Vaccine induced immune mediated 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.

KW - COVID-19

KW - Cerebral venous thrombosis

KW - Vaccination

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DO - 10.1016/j.jns.2021.117532

M3 - Review article

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AN - SCOPUS:85107730447

SN - 0022-510X

VL - 427

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

M1 - 117532

ER -

Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

Abstract

Keywords

ASJC Scopus subject areas

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