PB0099 - Arterial and venous thrombosis induced by vaccination with ChAdOx1 nCov-19 (Astrazeneca) against Coronavirus 19 (COVID19)

Background: The biggest pharmaceutical break-through during the Coronavirus 19 (COVID 19) pandemic was the development of vaccines. Vaccine-induced thrombocytopenic thrombosis (VITT) is a rare but severe and/or fatal complication associated with adenoviral vector-based vaccines. It is a prothrombotic disorder confirmed by the finding of antibodies against Platelet Factor 4 (PF4). To date, approximately 40 cases of VITT have been published, sixty‐seven percent (27/40) of patients were females, median age was 40.5 years.
We describe a case occurs in a previously healthy young women receiving the first dose of ChAdOx1 nCov-19 (Astrazeneca), 1 or 2 weeks after developing symptoms.

Aims: Describe clinical manifestations and management of a patient with arterial and venous thrombosis with thrombocytopenia following vaccination with ChAdOx1 nCov-19.

Methods: Clinical history, laboratory data, diagnostic imaging (computed tomography, arterial and venous Doppler ultrasound and transcranial Doppler, cerebral arteriography), surgical intervention and electroencephalogram.

Results: A 27-year-old woman, without pathological history, arrived to the Emergency Room with expression aphasia and right hemiparesis, 10 days after vaccination for COVID 19 with ChAdOx1 nCov-19 . (Astrazeneca)
CT scan: extensive left intraparenchymal hematoma.
Arteriography: left sylvian thrombosis.
Intercurred with bilateral radial arterial thrombosis, venous thrombosis and pulmonary thromboembolism.
Thrombocytopenia, hypofibrinogenemia, elevated D-dimer, and Positive PF4 Antibodies (Asserachrom HPIA Anti PF4/ Heparin IgG) confirmed the diagnosis of VITT.
Treatment: evacuation of intraparenchymal hematoma, decompressive craniectomy and high doses of immunoglobulin, corticosteroids, and anticoagulation with Apixaban. She evolved with digital necrosis of the left thumb with partial amputation of said finger. Prolonged mechanical ventilation GCS (Glasgow Coma Scale) 10/15 and right hemiplegia.

Conclusion(s): Suspicion and early recognition of VITT is associated with better outcomes. Our patient presents the diagnostic criteria for VITT: thrombocytopenia, hypofibrinogenemia, elevated D-dimer and positive PF4 Antibodies. The basis of treatment was , immunoglobulin, anticoagulation (avoiding heparin) and corticosteroids . Neurological sequelae were inherent to the initial bleeding event.