Thrombocytopenia with acute ischemic stroke and bleeding in a patient newly vaccinated with an adenoviral vector-based COVID-19 vaccine

J Thromb Haemost. 2021 Jul;19(7):1771-1775. doi: 10.1111/jth.15347. Epub 2021 May 5.


We describe the first Danish case of presumed inflammatory and thrombotic response to vaccination with an adenoviral (ChAdOx1) vector-based COVID-19 vaccine (AZD1222). The case describes a 60-year-old woman who was admitted with intractable abdominal pain 7 days after receiving the vaccine. Computed tomography of the abdomen revealed bilateral adrenal hemorrhages. On the following day, she developed a massive right-sided ischemic stroke and magnetic resonance imaging angiography showed occlusion of the right internal carotid artery. The ischemic area was deemed too large to offer reperfusion therapy. During admission, blood tests showed a remarkable drop in platelet counts from 118,000 to 5000 per μl and a substantial increase in D-dimer. The patient died on the sixth day of hospitalization. Blood tests revealed platelet factor 4 reactive antibodies, imitating what is seen in heparin-induced thrombocytopenia. This may be a novel immune-mediated response to the vaccine.

Keywords: hemorrhage; platelet factor; stroke; thrombocytopenia; vaccines.

Publication types

  • Case Reports

MeSH terms

  • Brain Ischemia* / diagnosis
  • COVID-19 Vaccines
  • COVID-19*
  • ChAdOx1 nCoV-19
  • Female
  • Hemorrhage
  • Humans
  • Ischemic Stroke*
  • Middle Aged
  • SARS-CoV-2
  • Stroke* / diagnosis
  • Thrombocytopenia*
  • Vaccines*


  • COVID-19 Vaccines
  • Vaccines
  • ChAdOx1 nCoV-19