Acute Ischemic Stroke Revealing ChAdOx1 nCov-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia: Impact on Recanalization Strategy

J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105942. doi: 10.1016/j.jstrokecerebrovasdis.2021.105942. Epub 2021 Jun 24.

Abstract

Vaccine-induced immune thrombotic thrombocytopenia is a rare syndrome following the ChAdOx1 nCov-19 or Ad26.COV2.S vaccine. Reported patients developed mainly venous thrombosis. We describe a case of a young healthy women suffering from acute ischemic stroke due to large vessel occlusion without cerebral venous thrombosis 8 days after vaccination and its consequences on recanalization strategy. Considering the thrombocytopenia, intravenous thrombolysis was contraindicated. She underwent mechanical thrombectomy with complete recanalization and dramatically improved clinically. Positive detection of anti-PF4-heparin-antibodies confirmed vaccine-induced immune thrombotic thrombocytopenia diagnosis. In case of acute ischemic stroke after recent ChAdOx1 nCov-19 or Ad26.COV2.S vaccine, platelet count should be systematically checked before giving thrombolysis, and direct mechanical thrombectomy should be proposed in patients with large vessel occlusion.

Keywords: Intravenous thombolysis; Thrombectomy; Thrombocytopenia; nCov-19 vaccination; stroke.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies / blood
  • Blood Platelets / immunology
  • COVID-19 Vaccines / administration & dosage
  • COVID-19 Vaccines / adverse effects*
  • ChAdOx1 nCoV-19
  • Female
  • Heparin / immunology
  • Humans
  • Ischemic Stroke / blood
  • Ischemic Stroke / chemically induced
  • Ischemic Stroke / diagnosis
  • Ischemic Stroke / therapy*
  • Platelet Factor 4 / immunology
  • Purpura, Thrombotic Thrombocytopenic / blood
  • Purpura, Thrombotic Thrombocytopenic / chemically induced
  • Purpura, Thrombotic Thrombocytopenic / diagnosis
  • Purpura, Thrombotic Thrombocytopenic / therapy*
  • Thrombectomy*
  • Treatment Outcome
  • Vaccination / adverse effects*

Substances

  • Antibodies
  • COVID-19 Vaccines
  • PF4 protein, human
  • Platelet Factor 4
  • Heparin
  • ChAdOx1 nCoV-19