Baseline characteristics and laboratory markers of four patients presenting with cerebral venous sinus thrombosis following AstraZeneca/Oxford University ChAdOx1 nCoV-19 vaccine
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
| Sex | Female | Female | Female | Female |
| Age (years) | 46 | 41 | 43 | 46 |
| Medical history | Migraine | Migraine | Hypertension Deep Vein Thrombosis | Migraine |
| Clinical presentation | Headache, collapse, hemiparesis | Headaches, vomiting, abdominal pain | Shortness of breath, collapse headache, paraesthesia | Headache |
| No. of days post vaccine | 14 | 9 | 28 | 9 |
| Thrombosis | CVST | CVST Branch portal vein thrombus PE | CVST Pulmonary saddle embolus | CVST Hepatic vein thrombus Portal vein thrombus |
| Bleeding | Subarachnoid haemorrhage | None | Subarachnoid haemorrhage | None |
| 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)) | 2.48 | 2.19 | 2.35 | 2.18 |
| HYPHEN BioMed ELISA PF4 HIT-IgG (<0.4 OD) | 1.67 | 1.89 | 1.92 | 1.78 |
| Platelets (150–400×109) | 39 | 125 | 161 | 57 |
| D-dimer (<500 ng/mL), FEU | >20 000 | >20 000 | >20 000 | >20 000 |
| Fibrinogen (1.9–4.3 g/L) | 0.7 | 4.26 | 2.75 | 1.4 |
| Troponin (ng/L) (<19.8) | 4.3 | 54.8 | 4.6 | 1.6 |
| PT (12.8–17.4 s) | 14.7 | 13.5 | 14.8 | 12.0 |
| APTT (25.0–35.0 s) | 43.2 | 28.5 | 26.2 | 39.0 |
| DRVVT ratio | Negative | Negative | Negative | Negative |
| Antithrombin (70–130 IU/dL) | 107 | 110 | 123 | 114 |
| Protein C activity (70–130 IU/dL) | 72 | 155 | 65 | 144 |
| Free protein S antigen (70–130 IU/dL) | 68.8 | 119.0 | 102.8 | 92.7 |
| Factor VIII (50–150 IU/dL) | 64.3 | 172.7 | 59.2 | 193 |
| VWF:Ag (50–150 IU/dL) | 220 | 202.8 | 226.3 | 220.1 |
| VWF:Rco (50–150 IU/dL) | 235 | 192.2 | 236.1 | 178.1 |
| Plasminogen activity (70–130 IU/dL) | 72 | 101 | 84 | 94 |
| PAI-1 (ng/mL)*† | 10.1 | 12.9 | 38.3 | 25.8 |
| E-selectin*† | 6.9 | 14.0 | 9.9 | 7.2 |
| ICAM-1*† | 78.8 | 138.6 | 129.7 | 130.1 |
| VCAM-1*† | 1192.8 | 760.3 | 1605.8 | 1276.5 |
| Thrombomodulin*† | 4.9 | 3.9 | 6.0 | 5.9 |
| P-selectin*† | 33.1 | 37.3 | 82.4 | 59.7 |
| C3 (0.79–1.52 mg/dL) | 1.25 | 0.23 | 0.79 | 1.06 |
| C4 (0.16–0.38 mg/dL) | 0.10 | 0.35 | 0.12 | 0.25 |
| C3a (ng/mL)†‡ | 289.4 | 151.8 | 570.2 | 80.4 |
| C5b-9 (ng/mL)†‡ | 184.8 | 194.9 | 468.9 | 254.2 |
*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.