Vaccine-Induced Immune Thrombotic Thrombocytopenia with Disseminated Intravascular Coagulation and Death following the ChAdOx1 nCoV-19 Vaccine

J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105938. doi: 10.1016/j.jstrokecerebrovasdis.2021.105938. Epub 2021 Jun 23.

Abstract

Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Although COVID-19 is primarily a disease of the lungs with florid respiratory manifestations, there are increasing reports of cardiovascular, musculoskeletal, gastrointestinal, and thromboembolic complications. Developing an effective and reliable vaccine was emergently pursued to control the catastrophic spread of the global pandemic. We report a fatal case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute this fatal thrombotic condition to the vaccine due to the remarkable temporal relationship. The proposed mechanism of VITT is production of rogue antibodies against platelet factor-4 resulting in massive platelet aggregation. Healthcare providers should be aware of the possibility of such fatal complication, and the vaccine recipients should be warned about the symptoms of VITT.

Keywords: COVID-19; Cerebral Venous Sinus Thrombosis; Death; Disseminated Intravascular Coagulation; Vaccine; Vaccine-induced Immune Thrombotic Thrombocytopenia.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19 Vaccines / administration & dosage
  • COVID-19 Vaccines / adverse effects*
  • ChAdOx1 nCoV-19
  • Disseminated Intravascular Coagulation / blood
  • Disseminated Intravascular Coagulation / chemically induced*
  • Disseminated Intravascular Coagulation / diagnosis
  • Disseminated Intravascular Coagulation / physiopathology
  • Fatal Outcome
  • Female
  • Humans
  • Purpura, Thrombotic Thrombocytopenic / blood
  • Purpura, Thrombotic Thrombocytopenic / chemically induced*
  • Purpura, Thrombotic Thrombocytopenic / diagnosis
  • Purpura, Thrombotic Thrombocytopenic / physiopathology
  • Sagittal Sinus Thrombosis / diagnostic imaging
  • Sagittal Sinus Thrombosis / etiology*
  • Sagittal Sinus Thrombosis / physiopathology
  • Treatment Outcome
  • Vaccination / adverse effects*

Substances

  • COVID-19 Vaccines
  • ChAdOx1 nCoV-19