{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:10:46Z","timestamp":1770919846691,"version":"3.50.1"},"reference-count":7,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,9,10]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>A 40-year-old man with no cardiac history presented with central chest pain 8\u2009days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24\u00d710<jats:sup>9<\/jats:sup>\u2009\u03bcg\/L) and a raised d-dimer (&gt;110\u2009000\u2009\u03bcg\/L), and he was urgently transferred to our tertiary referral central for suspected vaccine-induced immune thrombocytopaenia and thrombosis (VITT). He developed dynamic ischaemic electrocardiographic changes with ST elevation, a troponin of 3185\u2009ng\/L, and regional wall motion abnormalities. An occlusion of his left anterior descending coronary artery was seen on CT coronary angiography. His platelet factor-4 (PF-4) antibody returned strongly positive. He was urgently treated for presumed VITT with intravenous immunoglobulin, methylprednisolone and plasma exchange, but remained thrombocytopaenic and was initiated on rituximab. Argatroban was used for anticoagulation for his myocardial infarction while he remained thrombocytopaenic. After 6\u2009days, his platelet count improved, and his PF-4 antibody level, troponin and d-dimer fell. He was successfully discharged after 14 days.<\/jats:p>","DOI":"10.1136\/bcr-2021-245218","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T12:58:58Z","timestamp":1632747538000},"page":"e245218","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Acute ST-segment elevation myocardial infarction secondary to vaccine-induced immune thrombosis with thrombocytopaenia (VITT)"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7204-609X","authenticated-orcid":false,"given":"Luke","family":"Flower","sequence":"first","affiliation":[{"name":"Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zdenek","family":"Bares","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgina","family":"Santiapillai","sequence":"additional","affiliation":[{"name":"Haematology Department, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"2025082710271855000_14.9.e245218.1","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/S0140-6736(20)31604-4","article-title":"Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1\/2, single-blind, randomised controlled trial","volume":"396","author":"Folegatti","year":"2020","journal-title":"The Lancet"},{"key":"2025082710271855000_14.9.e245218.2","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1056\/NEJMe2106315","article-title":"SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia","volume":"384","author":"Cines","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082710271855000_14.9.e245218.3","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa2104840","article-title":"Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination","volume":"22","author":"Greinacher","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082710271855000_14.9.e245218.4","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1056\/NEJMoa2105385","article-title":"Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination","volume":"384","author":"Scully","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082710271855000_14.9.e245218.5","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1016\/S2665-9913(20)30121-1","article-title":"Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia","volume":"2","author":"McGonagle","year":"2020","journal-title":"Lancet Rheumatol"},{"key":"2025082710271855000_14.9.e245218.6","doi-asserted-by":"crossref","first-page":"e754","DOI":"10.1016\/S2665-9913(20)30343-X","article-title":"Clinical criteria for COVID-19-associated hyperinflammatory syndrome: a cohort study","volume":"2","author":"Webb","year":"2020","journal-title":"Lancet Rheumatol"},{"key":"2025082710271855000_14.9.e245218.7","unstructured":"British Society for Haematology . Guidance produced from the expert haematology panel (EHP) focussed on syndrome of thrombosis and thrombocytopenia occurring after coronavirus vaccination. Available: https:\/\/b-s-h.org.uk\/about-us\/news\/guidance-produced-by-the-expert-haematology-panel-ehp-focussed-on-vaccine-induced-thrombosis-and-thrombocytopenia-vitt\/"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-245218","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:27:24Z","timestamp":1756315644000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-245218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":7,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,27]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/bcr-2021-245218"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-245218","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}