Table 1.

Clinical details of CVT cases after a second ChAdOx1 nCoV-19 dose

Patient 1Patient 2Patient 3Patient 4
VITT classification* Probable Definite Possible Unlikely 
Demographics     
 Age† 60s 50s 40s 60s 
 Sex Male Female Male Male 
Medical history Unremarkable Thrombophilia Unremarkable Unremarkable 
Prior COVID-19 infection at any time No No No No 
Baseline characteristics     
 Interval between first and second vaccination (d)‡ 90 44 62 77 
 Interval between second vaccination and symptom onset (d) 5 6 1 4 
 Interval between symptom onset and diagnosis (d) 0 1 0 0 
Headache No Yes Yes No 
Focal neurologic deficits Yes Yes Yes Yes 
Coma Yes Yes No No 
Seizure No No Yes Yes 
Imaging findings     
 Intracerebral hemorrhage Yes Yes No No 
 Location of CVT Superior sagittal sinus Superior sagittal sinus, left transverse and sigmoid sinus, straight sinus, left jugular vein Right transverse and sigmoid sinuses Superior sagittal sinus, right transverse and sigmoid sinus, right jugular vein 
Laboratory values     
 Platelet count at admission, ×109/L 188 40 109 175 
 Platelet count nadir, ×109/L 55 14 55 124 
 Anti-PF4 antibody ELISA Negative Positive Negative Negative 
Type ELISA test Lifecodes PF4 IgG from Immucor PF4 IgG from Immucor Lifecodes PF4 IgG from Immucor ZYMUTEST HIA IgG, HYPHEN BIOMED 
 Optical density ELISA 0.06 2.12§ 0.12 0.03 
 Optical density test threshold ≥0.4 ≥0.4 ≥0.4 ≥0.3 
 Functional assay to detect platelet- activating PF4 antibodies Positiveǁ Not performed Positiveǁ Negative 
Type of functional assay Modified HIPA NA Modified HIPA Multiplate HIMEA 
 D-dimer, ug/L FEU 35 200 29 100 2400 513 
 Fibrinogen, g/L 4.17 2.63 3.34 4.14 
 ref <3.50 ref <4.00 ref <3.50 ref <4.50 
Treatment     
 Anticoagulation Argatroban None# Argatroban followed by dabigatran Fondaparinux followed by dabigatran 
 IVIG Yes No Yes No 
 Decompressive hemicraniectomy Yes No No No 
Complications and outcome     
 Major bleeding during admission Yes** No No No 
 New VTE during admission No Yes, pelvic veins No No 
 Outcome at hospital discharge Dead Dead No disability No disability 
 Days between symptom onset and  death 2 3 NA NA 
 Cause of death Brain herniation Brain herniation NA NA 
Patient 1Patient 2Patient 3Patient 4
VITT classification* Probable Definite Possible Unlikely 
Demographics     
 Age† 60s 50s 40s 60s 
 Sex Male Female Male Male 
Medical history Unremarkable Thrombophilia Unremarkable Unremarkable 
Prior COVID-19 infection at any time No No No No 
Baseline characteristics     
 Interval between first and second vaccination (d)‡ 90 44 62 77 
 Interval between second vaccination and symptom onset (d) 5 6 1 4 
 Interval between symptom onset and diagnosis (d) 0 1 0 0 
Headache No Yes Yes No 
Focal neurologic deficits Yes Yes Yes Yes 
Coma Yes Yes No No 
Seizure No No Yes Yes 
Imaging findings     
 Intracerebral hemorrhage Yes Yes No No 
 Location of CVT Superior sagittal sinus Superior sagittal sinus, left transverse and sigmoid sinus, straight sinus, left jugular vein Right transverse and sigmoid sinuses Superior sagittal sinus, right transverse and sigmoid sinus, right jugular vein 
Laboratory values     
 Platelet count at admission, ×109/L 188 40 109 175 
 Platelet count nadir, ×109/L 55 14 55 124 
 Anti-PF4 antibody ELISA Negative Positive Negative Negative 
Type ELISA test Lifecodes PF4 IgG from Immucor PF4 IgG from Immucor Lifecodes PF4 IgG from Immucor ZYMUTEST HIA IgG, HYPHEN BIOMED 
 Optical density ELISA 0.06 2.12§ 0.12 0.03 
 Optical density test threshold ≥0.4 ≥0.4 ≥0.4 ≥0.3 
 Functional assay to detect platelet- activating PF4 antibodies Positiveǁ Not performed Positiveǁ Negative 
Type of functional assay Modified HIPA NA Modified HIPA Multiplate HIMEA 
 D-dimer, ug/L FEU 35 200 29 100 2400 513 
 Fibrinogen, g/L 4.17 2.63 3.34 4.14 
 ref <3.50 ref <4.00 ref <3.50 ref <4.50 
Treatment     
 Anticoagulation Argatroban None# Argatroban followed by dabigatran Fondaparinux followed by dabigatran 
 IVIG Yes No Yes No 
 Decompressive hemicraniectomy Yes No No No 
Complications and outcome     
 Major bleeding during admission Yes** No No No 
 New VTE during admission No Yes, pelvic veins No No 
 Outcome at hospital discharge Dead Dead No disability No disability 
 Days between symptom onset and  death 2 3 NA NA 
 Cause of death Brain herniation Brain herniation NA NA 

ELISA, enzyme-linked immunosorbent assay; FEU, fibrinogen equivalent units; HIMEA, heparin-induced multiple electrode aggregometry; HIPA, heparin-induced platelet aggregation; IVIG, intravenous immune globulin; NA, not applicable; VTE, venous thromboembolism.

*

According to the United Kingdom expert hematology panel.9 

†

To avoid the possibility of patient identification, exact age has been removed.

‡

In all cases, the first vaccination was ChAdOx1 nCoV-19.

§

Blood was drawn from the patient at admission, stored at 4°C for 1 wk, then stored at −20°C for 327 d before it was tested.

ǁ

Modified HIPA assay was performed as previously described.15 

HIMEA assay was performed as previously described.16 

#

Reason: multiple intracerebral hemorrhages and diffuse subarachnoid hemorrhage.

**

Worsening of intracerebral hemorrhages.

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