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Vaccines for COVID-19 were developed with unprecedented speed and since January 2021, the AstraZeneca/Oxford University ChAdOx1 nCoV-19 vaccine has been administered to over 400 million people globally.1 In April 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency reported a possible association between ChAdOx1 nCoV-19 and a rare syndrome of unusual site thrombosis combined with thrombocytopenia, termed vaccine-induced immune thrombotic thrombocytopenia (VITT). Frequency of VITT varies across age groups. Overall, 411 cases of VITT have been reported to the MHRA by 21 July 2021 with fatality rate of 17.76% (73/411).2
We report our experience of four VITT cases from a single tertiary referral centre in London, UK, who suffered cerebral venous sinus thrombosis (CVST) with or without thrombosis elsewhere. Baseline clinical and laboratory features are shown in table 1. Informed written consent was obtained from all patients before publication. All patients fulfilled the proposed diagnostic criteria for VITT3 4. Each case was reportedvia the MHRA Yellow card scheme and other national VITT–CVST surveillance projects.
All four patients were women aged 41–46 years and diagnosed with VITT 7–28 days post ChAdOx1 nCov-19 vaccination. Each presented with headache and varying degrees of neurological deficit. Detailed case histories are provided in the online supplemental material. Neuroimaging for patient 1 demonstrated extensive thrombosis involving both the dural venous sinuses and superficial cortical veins as well as associated subarachnoid haemorrhage in the parietal sulci bilaterally (figure 1A–D) but no thrombosis detected in imaging of the abdomen. Patient 2 initially presented with superior sagittal sinus thrombosis associated with right-sided neurological deficit (figure 1E), branch intrahepatic portal venous thrombus and non-occlusive segmental pulmonary arteries filling defects consistent …
CC-T and CP contributed equally.
Contributors DJA conceived the study, involved in data collection, data verification, data analysis, figures and data interpretation, wrote the original draft and reviewed and edited the manuscript. CC-T contributed to data collection, data verification, data analysis, figures and writing and editing the original manuscript. CP performed some of the laboratory assays and involved in data analysis, data interpretation and writing and editing of the manuscript. ML interpreted the data and wrote and revised the manuscript. JB and AR contributed to data collection. NA and SR provided radiology images and edited the manuscript. AS and SB contributed to writing the manuscript. All authors reviewed and approved the final version of the manuscript.
Funding This study was partly funded by Imperial College COVID19 Research Fund (P88531 received by DJA and G26266 received by CP and DJA). CP was funded by Versus Arthritis (21223).
Competing interests DJA received research funding from Bayer PLC and Leo Pharma outside of this research project. ML received consultation and speaker fees from AstraZeneca, Sobi, Leo Pharma, Takeda and Pfizer but it was not related to this research project. Others have no conflict of interests to declare.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.