Clinical characteristics of the 9 patients with VITT-like prothrombotic disease without proximate exposure to heparin or vaccination
| . | Patient 1∗ . | Patient 2† . | Patient 3 . | Patient 4 . | Patient 5 . | Patient 6 . | Patient 7 . | Patient 8‡ . | Patient 9 . |
|---|---|---|---|---|---|---|---|---|---|
| Sex, age (y) | Female, 70-80 y | Female, 30-40 y | Female, 70-80 y | Male, 60-70 y | Female, 20-30 y | Female, 30-40 y | Male, 60-70 y | Male, 20-30 y | Male, 5-10 y |
| Symptoms | Variable | Severe Headache | Dyspnea | Neurological symptoms | Common cold, severe headache with hemianopia | N/A | Dyspnea | Severe headache | Severe headache, vomiting, nausea |
| Diagnosis | Recurrent DVT and PE, stroke over 3 y | CVST with secondary bleeding | PE | Stroke with secondary intracranial bleeding | CVST with secondary bleeding, PE, portal vein thrombosis | Recurrent venous and arterial thrombotic events over 13 years, including stroke | Bilateral DVT with PE | CVST with secondary bleeding | CVST |
| Preceding infection (interval to admission) | — | Common cold (7 d) | — | — | Respiratory syncytial virus (unknown, active at admission) | — | Urinary tract infection (11 d) | Common cold (14 d) | Adenovirus (10 d) |
| Other underlying disease | Monoclonal gammopathy | — | — | — | — | — | Crohn‘s disease | — | — |
| Therapy | Multiple anticoagulants and platelet aggregation inhibitors | Argatroban, IVIG | Unfractioned heparin, fondaparinux, apixaban | Plasma exchange, fondaparinux, apixaban | Unfractionated heparin, followed by VKA | Multiple anticoagulants and platelet aggregation inhibitors, over 13 y, IVIG, plasmapheresis | Patient refused further therapy | Unfractioned heparin; followed by fondaparinux; prednisolone | LMWH, rivaroxaban, dexamethasone, acetazolamide |
| Outcome | PLT count stabilized in lower reference range, lately no further thromboembolism | Fatal | Recovered | Recovered with persistent sequelae from stroke | Recovered | Recurrent relapses | Fatal | Recovered with persistent sequelae from CVST | Recovered |
| . | Patient 1∗ . | Patient 2† . | Patient 3 . | Patient 4 . | Patient 5 . | Patient 6 . | Patient 7 . | Patient 8‡ . | Patient 9 . |
|---|---|---|---|---|---|---|---|---|---|
| Sex, age (y) | Female, 70-80 y | Female, 30-40 y | Female, 70-80 y | Male, 60-70 y | Female, 20-30 y | Female, 30-40 y | Male, 60-70 y | Male, 20-30 y | Male, 5-10 y |
| Symptoms | Variable | Severe Headache | Dyspnea | Neurological symptoms | Common cold, severe headache with hemianopia | N/A | Dyspnea | Severe headache | Severe headache, vomiting, nausea |
| Diagnosis | Recurrent DVT and PE, stroke over 3 y | CVST with secondary bleeding | PE | Stroke with secondary intracranial bleeding | CVST with secondary bleeding, PE, portal vein thrombosis | Recurrent venous and arterial thrombotic events over 13 years, including stroke | Bilateral DVT with PE | CVST with secondary bleeding | CVST |
| Preceding infection (interval to admission) | — | Common cold (7 d) | — | — | Respiratory syncytial virus (unknown, active at admission) | — | Urinary tract infection (11 d) | Common cold (14 d) | Adenovirus (10 d) |
| Other underlying disease | Monoclonal gammopathy | — | — | — | — | — | Crohn‘s disease | — | — |
| Therapy | Multiple anticoagulants and platelet aggregation inhibitors | Argatroban, IVIG | Unfractioned heparin, fondaparinux, apixaban | Plasma exchange, fondaparinux, apixaban | Unfractionated heparin, followed by VKA | Multiple anticoagulants and platelet aggregation inhibitors, over 13 y, IVIG, plasmapheresis | Patient refused further therapy | Unfractioned heparin; followed by fondaparinux; prednisolone | LMWH, rivaroxaban, dexamethasone, acetazolamide |
| Outcome | PLT count stabilized in lower reference range, lately no further thromboembolism | Fatal | Recovered | Recovered with persistent sequelae from stroke | Recovered | Recurrent relapses | Fatal | Recovered with persistent sequelae from CVST | Recovered |