{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T19:56:07Z","timestamp":1770062167795,"version":"3.49.0"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T00:00:00Z","timestamp":1617926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the \u201cCOVID-19 vaccine AstraZeneca\u201d. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with \u201cCOVID-19 vaccine AstraZeneca\u201d were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the \u201cCOVID-19 vaccine AstraZeneca\u201d might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients\u2019 treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena.<\/jats:p>","DOI":"10.3390\/jcm10081599","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T03:04:06Z","timestamp":1618196646000},"page":"1599","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":124,"title":["Thrombocytopenia and Intracranial Venous Sinus Thrombosis after \u201cCOVID-19 Vaccine AstraZeneca\u201d Exposure"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7683-6918","authenticated-orcid":false,"given":"Marc E.","family":"Wolf","sequence":"first","affiliation":[{"name":"Neurologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany"},{"name":"Department of Neurology, Universit\u00e4tsmedizin Mannheim, University of Heidelberg, D-68167 Mannheim, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beate","family":"Luz","sequence":"additional","affiliation":[{"name":"Zentralinstitut f\u00fcr Transfusionsmedizin und Blutspendedienst, Klinikum Stuttgart, D-70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5456-0527","authenticated-orcid":false,"given":"Ludwig","family":"Niehaus","sequence":"additional","affiliation":[{"name":"Neurologie, Rems-Murr-Klinikum Winnenden, D-71364 Winnenden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pervinder","family":"Bhogal","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1FR, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8944-8239","authenticated-orcid":false,"given":"Hansj\u00f6rg","family":"B\u00e4zner","sequence":"additional","affiliation":[{"name":"Neurologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany"},{"name":"Department of Neurology, Universit\u00e4tsmedizin Mannheim, University of Heidelberg, D-68167 Mannheim, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6534-036X","authenticated-orcid":false,"given":"Hans","family":"Henkes","sequence":"additional","affiliation":[{"name":"Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany"},{"name":"Medical Faculty, University Duisburg-Essen, D-47057 Duisburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1161\/STROKEAHA.116.013617","article-title":"Cerebral venous sinus thrombosis incidence is higher than previously thought: A retrospective population-based study","volume":"47","author":"Devasagayam","year":"2016","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3375","DOI":"10.1161\/STROKEAHA.112.671453","article-title":"The incidence of cerebral venous thrombosis: A cross-sectional study","volume":"43","author":"Coutinho","year":"2012","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1038\/nrneurol.2017.104","article-title":"Cerebral venous thrombosis","volume":"13","author":"Silvis","year":"2017","journal-title":"Nat. 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