{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:38:54Z","timestamp":1778870334174,"version":"3.51.4"},"reference-count":59,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>In the spring of 2021, reports of rare and unusual venous thrombosis in association with the ChAdOx1 and Ad26.COV2.S adenovirus-based coronavirus vaccines led to a brief suspension of their use by several countries. Thromboses in the cerebral and splanchnic veins among patients vaccinated in the preceding 4 weeks were described in 17 patients out of 7.98 million recipients of the Ad26.COV2.S vaccine (with 3 fatalities related to cerebral vein thrombosis) and 169 cases of cerebral vein thrombosis among 35 million ChAdOx1 recipients. Events were associated with thrombocytopenia and anti-PF4 (antibodies directed against platelet factor 4), leading to the designation vaccine-induced immune thrombotic thrombocytopenia. Unlike the related heparin-induced thrombotic thrombocytopenia, with an estimated incidence of &lt;1:1000 patients treated with heparin, and a mortality rate of 25%, vaccine-induced immune thrombotic thrombocytopenia has been reported in 1:150\u2009000 ChAdOx1 recipients and 1:470\u2009000 Ad26.COV.2 recipients, with a reported mortality rate of 20% to 30%. Early recognition of this complication should prompt testing for anti-PF4 antibodies and acute treatment targeting the autoimmune and prothrombotic processes. Intravenous immunoglobulin (1 g\/kg for 2 days), consideration of plasma exchange, and nonheparin anticoagulation (argatroban, fondaparinux) are recommended. In cases of cerebral vein thrombosis, one should monitor for and treat the known complications of venous congestion as they would in patients without vaccine-induced immune thrombotic thrombocytopenia. Now that the Ad26.COV2.S has been reapproved for use in several countries, it remains a critical component of our pharmacological armamentarium in stopping the spread of the human coronavirus and should be strongly recommended to patients. At this time, the patient and community-level benefits of these two adenoviral vaccines vastly outweigh the rare but serious risks of vaccination. Due to the relatively low risk of severe coronavirus disease 2019 (COVID-19) in young women (&lt;50 years), it is reasonable to recommend an alternative vaccine if one is available. Ongoing postmarketing observational studies are important for tracking new vaccine-induced immune thrombotic thrombocytopenia cases and other rare side effects of these emergent interventions.<\/jats:p>","DOI":"10.1161\/strokeaha.121.035613","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T09:00:33Z","timestamp":1627290033000},"page":"3045-3053","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Cerebral Vein Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia"],"prefix":"10.1161","volume":"52","author":[{"given":"James E.","family":"Siegler","sequence":"first","affiliation":[{"name":"Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7468-137X","authenticated-orcid":true,"given":"Piers","family":"Klein","sequence":"additional","affiliation":[{"name":"Boston Medical Center, Boston University School of Medicine, MA (P.K., M.A., T.N.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shadi","family":"Yaghi","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0540-4816","authenticated-orcid":true,"given":"Nicholas","family":"Vigilante","sequence":"additional","affiliation":[{"name":"Cooper Medical School of Rowan University, Camden, NJ (N.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Abdalkader","sequence":"additional","affiliation":[{"name":"Boston Medical Center, Boston University School of Medicine, MA (P.K., M.A., T.N.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam University Medical Centers, the Netherlands (J.M.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feras","family":"Abdul Khalek","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Internal Medicine, NYU Langone Medical Center, New York, NY (F.A.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Boston Medical Center, Boston University School of Medicine, MA (P.K., M.A., T.N.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30120-1"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.06.007"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12439"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493020959216"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030335"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011885"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011885"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30527-0"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00370-6"},{"key":"e_1_3_4_11_2","first-page":"95","article-title":"Emergence of SARS-CoV-2 b. 1.1. 7 lineage\u2014united states, december 29, 2020--january 12, 2021.","volume":"70","author":"Galloway SE","year":"2021","unstructured":"Galloway, SE, Paul, P, MacCannell, DR, Johansson, MA, Brooks, JT, MacNeil, A, Slayton, RB, Tong, S, Silk, BJ, Armstrong, GL, et al. Emergence of SARS-CoV-2 b. 1.1. 7 lineage\u2014united states, december 29, 2020--january 12, 2021. MMWR Surveill Summ. 2021;70:95.","journal-title":"MMWR Surveill Summ"},{"key":"e_1_3_4_12_2","article-title":"Safety and efficacy of the ChAdOx1 nCoV-19 (AZD1222) Covid-19 vaccine against the B. 1.351 variant in South Africa.","author":"Madhi SA","year":"2021","unstructured":"Madhi, SA, Baillie, V, Cutland, CL, Voysey, M, Koen, AL, Fairlie, L, Padayachee, SD, Dheda, K, Barnabas, SL, Bhorat, QE, et al. Safety and efficacy of the ChAdOx1 nCoV-19 (AZD1222) Covid-19 vaccine against the B. 1.351 variant in South Africa. New Engl J Med. 2021. [published online March 16, 2021]. https:\/\/www.nejm.org\/doi\/full\/10.1056\/nejmoa2102214#:~:text=Interim%20results%20from%20South%20Africa,1.351%20variant.&text=The%20Ad26. Accessed Apr 25, 2021.","journal-title":"New Engl J Med"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n296"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00628-0"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2034577"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32661-1"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2034201"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00234-8"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31605-6"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035389"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.09.065"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105392"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013739"},{"key":"e_1_3_4_24_2","unstructured":"NIH ACTIV Trial of Blood Thinners Pauses Enrollment of Critically ill COVID-19 Patients. 2020. https:\/\/www.nih.gov\/news-events\/news-releases\/nih-activ-trial-blood-thinners-pauses-enrollment-critically-ill-covid-19-patients. Accessed Apr 25 2021."},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1101\/2021.03.10.21252749"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105733"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2020.117183"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","unstructured":"Al-Mufti F Amuluru K Sahni R Bekelis K Karimi R Ogulnick J Cooper J Overby P Nuoman R Tiwari A et al. Cerebral venous thrombosis in COVID-19: a New York Metropolitan Cohort Study [published online April 22 2021]. AJNR Am J Neuroradiol. doi: 10.3174\/ajnr.A7134. http:\/\/www.ajnr.org\/content\/early\/2021\/04\/22\/ajnr.A7134. Accessed April 25 2021.","DOI":"10.3174\/ajnr.A7134"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14727"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2021.117448"},{"key":"e_1_3_4_31_2","unstructured":"Pinho AC. AstraZeneca\u2019s COVID-19 Vaccine: EMA Finds Possible Link to Very Rare Cases of Unusual Blood Clots with Low Blood Platelets. 2021. https:\/\/www.ema.europa.eu\/en\/news\/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood. Accessed May 16 2021."},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1114"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7018e2"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.7517"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10081599"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2104840"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2104882"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2105385"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2021.04.006"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-021-03572-y"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021011958"},{"key":"e_1_3_4_42_2","unstructured":"ACIP April 14 2021 Presentation Slides. 2021. [published Apr 14 2021] https:\/\/www.cdc.gov\/vaccines\/acip\/meetings\/slides-2021-04.html. Accessed May 16 2021."},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2101765"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30476-X"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPG0MNR5NGKNFX"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH16-02-0109"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198703053161004"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035564"},{"key":"e_1_3_4_49_2","unstructured":"Brooks JT Su JR Connors JM Kreuziger LB. Triage and Treatment of Patients with Potential Vaccine-induced Immune Thrombocytopenia (VITT) Post J&J Covid-19 vaccination. 2021. https:\/\/www.zoomgov.com\/rec\/play\/Yr3V913G4fZZnvKXa4Jmqe_dfJ-Pt-lseD8jPLIYzGH8U2ikES7183Tx_IgYqLAor7iehmzCZNx3uWru.nivW996P0qKRnGrz?continueMode=true. Accessed April 25 2021."},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e31820a8364"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2010.04.015"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024489"},{"key":"e_1_3_4_53_2","unstructured":"International Society on Thrombosis and Haemostasis. ISTH Interim Guidance for the Diagnosis and Treatment on VaccineInduced Immune Thrombotic Thrombocytopenia. 2021. [published online Apr 20 2021] https:\/\/cdn.ymaws.com\/www.isth.org\/resource\/resmgr\/ISTH_VITT_Guidance_2.pdf. Accessed April 25 2021."},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.05.025"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000567"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.1022"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-010-9421-7"},{"key":"e_1_3_4_58_2","unstructured":"Center for Disease Control. FDA and CDC Lift Recommended Pause on Johnson & Johnson (Janssen) COVID-19 Vaccine Use Following Thorough Safety Review [Internet]. [published online Apr 23 2021]. https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-and-cdc-lift-recommended-pause-johnson-johnson-janssen-covid-19-vaccine-use-following-thorough. Accessed April 25 2021."},{"key":"e_1_3_4_59_2","unstructured":"Coronavirus vaccine - weekly summary of Yellow Card reporting. [published update online May 5 2021]. https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-vaccine-adverse-reactions\/coronavirus-vaccine-summary-of-yellow-card-reporting. Accessed May 16 2021."},{"key":"e_1_3_4_60_2","unstructured":"Centers for Disease Control. Vaccines for COVID-19. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/index.html. Accessed April 25 2021."}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.121.035613","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:15:11Z","timestamp":1715613311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.121.035613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":59,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1161\/STROKEAHA.121.035613"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.121.035613","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]},"assertion":[{"value":"2021-07-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}