Table 1

Baseline characteristics and laboratory markers of four patients presenting with cerebral venous sinus thrombosis following AstraZeneca/Oxford University ChAdOx1 nCoV-19 vaccine

Patient 1Patient 2Patient 3Patient 4
SexFemaleFemaleFemaleFemale
Age (years)46414346
Medical historyMigraineMigraineHypertension
Deep Vein Thrombosis
Migraine
Clinical presentationHeadache, collapse, hemiparesisHeadaches,
vomiting, abdominal pain
Shortness of breath, collapse headache, paraesthesiaHeadache
No. of days post vaccine149289
ThrombosisCVSTCVST
Branch portal vein thrombus
PE
CVST
Pulmonary saddle embolus
CVST
Hepatic vein thrombus
Portal vein thrombus
BleedingSubarachnoid haemorrhageNoneSubarachnoid haemorrhageNone
Admission bloods
HemosIL AcuStar HIT-IgG* (<1 U/mL)0.05 (neg)0.03 (neg)0.04 (neg)0.02 (neg)
Immucor ELISA PF4 HIT-IgG (<0.4 Optical Density (OD))2.482.192.352.18
HYPHEN BioMed ELISA PF4 HIT-IgG (<0.4 OD)1.671.891.921.78
Platelets (150–400×109)3912516157
D-dimer (<500 ng/mL), FEU>20 000>20 000>20 000>20 000
Fibrinogen (1.9–4.3 g/L)0.74.262.751.4
Troponin (ng/L) (<19.8)4.354.84.61.6
PT (12.8–17.4 s)14.713.514.812.0
APTT (25.0–35.0 s)43.228.526.239.0
DRVVT ratioNegativeNegativeNegativeNegative
Antithrombin (70–130 IU/dL)107110123114
Protein C activity (70–130 IU/dL)7215565144
Free protein S antigen
(70–130 IU/dL)
68.8119.0102.892.7
Factor VIII (50–150 IU/dL)64.3172.759.2193
VWF:Ag (50–150 IU/dL)220202.8226.3220.1
VWF:Rco (50–150 IU/dL)235192.2236.1178.1
Plasminogen activity (70–130 IU/dL)721018494
PAI-1 (ng/mL)*†10.112.938.325.8
E-selectin*†6.914.09.97.2
ICAM-1*†78.8138.6129.7130.1
VCAM-1*†1192.8760.31605.81276.5
Thrombomodulin*†4.93.96.05.9
P-selectin*†33.137.382.459.7
C3 (0.79–1.52 mg/dL)1.250.230.791.06
C4 (0.16–0.38 mg/dL)0.100.350.120.25
C3a (ng/mL)†‡289.4151.8570.280.4
C5b-9 (ng/mL)†‡184.8194.9468.9254.2
  • *Mean (range) levels in eight control plasma samples tested in parallel: PAI-1: 4.1 (2.9–6.7); E-selectin: 7.5 (2.8–13.5); ICAM-1: 98.8 (77.0–148.0); VCAM-1: 671.9 (190.7–1076); thrombomodulin: 5.1 (4.8–5.8) and P-selectin: 26.5 (0–34.7) ng/mL.

  • †Performed in postadmission bloods.

  • ‡Mean (range) in control plasma as defined by manufacturer: C3a: 129.6 (33.8–268.1) and C5b-9: 147 (75–219) ng/mL. Values in bold are abnormal.

  • APTT, activated partial thromboplastin time; CVST, cerebral venous sinus thrombosis; DRVVT, dilute Russell's viper venom time; ICAM-1, intercellular adhesion molecule-1; PAI-1, plasminogen activator inhibitor-1; PE, pulmonary embolus; PF4, platelet factor 4; PT, prothrombin time; VCAM-1, vascular cell adhesion molecule-1; VWF:Ag, Von Willebrand antigen; VWF:Rco, Von Willebrand factor ristocetin factor.