COVID-19 vaccination and clots in unusual locations: key points
| • The majority of thrombotic events associated with COVID-19 are DVT and pulmonary embolism |
| • An increasing number of reports of splanchnic and CVT have been reported in association with COVID-19 infection |
| • Although the incidence of postvaccination atypical thrombosis remains quite low, 9 cases of CVT and 3 cases of SVT have been reported after vaccination with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine as well as 6 cases of CVT and 2 of concomitant SVT after Johnson & Johnson's Janssen Ad26.COV2.S vaccine |
| ○ The literature surrounding the incidence, risk, and pathophysiology continues to evolve even as this article was written |
| ○ These cases have been associated with thrombocytopenia resembling autoimmune heparin-induced thrombocytopenia |
| ○ The ISTH has developed treatment guidelines that include nonheparin anticoagulants as well as IVIG in confirmed cases |
| • Most patients had no obvious underlying risk factors or known thrombophilia |
| • Most patients were treated with anticoagulant therapy |
| • Mortality was high |
| • COVID-19 testing should be considered as well as ascertainment of vaccine status, product, and timing in patients who present with unexplained splanchnic or CVT |
| • The majority of thrombotic events associated with COVID-19 are DVT and pulmonary embolism |
| • An increasing number of reports of splanchnic and CVT have been reported in association with COVID-19 infection |
| • Although the incidence of postvaccination atypical thrombosis remains quite low, 9 cases of CVT and 3 cases of SVT have been reported after vaccination with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine as well as 6 cases of CVT and 2 of concomitant SVT after Johnson & Johnson's Janssen Ad26.COV2.S vaccine |
| ○ The literature surrounding the incidence, risk, and pathophysiology continues to evolve even as this article was written |
| ○ These cases have been associated with thrombocytopenia resembling autoimmune heparin-induced thrombocytopenia |
| ○ The ISTH has developed treatment guidelines that include nonheparin anticoagulants as well as IVIG in confirmed cases |
| • Most patients had no obvious underlying risk factors or known thrombophilia |
| • Most patients were treated with anticoagulant therapy |
| • Mortality was high |
| • COVID-19 testing should be considered as well as ascertainment of vaccine status, product, and timing in patients who present with unexplained splanchnic or CVT |
IVIG, intravenous immunoglobulin.