Doctors in Denver treated a 40-year-old woman with atypical thrombosis that happened after COVID-19 vaccination without using heparin. They described their treatment in a case study that can be used as a road map to treat others.
Person Getting Vaccinated
Doctors in the emergency department of Denver Health Hospital in Colorado treated a 40-year-old woman who complained of severe headaches, sinus pressure, muscle pain, and a particularly dry throat. She had no history of thrombosis or circulatory problems, cancer, or clotting problems. The doctors prescribed treatment based on her symptoms without asking for tests. Four days later, she went back to the emergency room. This headache was still present, especially when moving or when the light was too strong.
A case of atypical thrombosis after vaccination
This woman had no fever, no weakness, no vision or speech problems. Her coronavirus screening test was negative and her vital signs were normal. However, the patient mentioned that she had been vaccinated 12 days earlier with Johnson & Johnson’s COVID-19 vaccine. Her blood tests showed that she had thrombocytopenia and an elevated D-dimer level. These two biological markers indicate atypical thrombocytopenic thrombosis. In addition, the patient had anti-PF4 autoantibodies, another marker for vaccine-induced thrombocytopenic thrombosis (VITT).
To confirm this diagnosis, the patient underwent a brain scan. On the image, doctors saw cerebral venous thrombosis in the left transverse sinus extending to the jugular vein. She had all the known signs of VITT. How was she treated, knowing that the CDC advises against the use of heparin, an anticoagulant, in the treatment of cases of VITT?
A treatment without heparin
The doctors decided to administer Bivalirudin (Angiomax) to her intravenously. Bivalirudin is an anticoagulant that specifically inhibits thrombin, one of the clotting factors. The patient continued to take the drug for six days, during which time her platelet count normalized. After discharge, her headaches disappeared and she no longer suffered from her cerebral venous thrombosis.
This case study is the first to describe the treatment of VITT with an alternative to heparin. If it worked for this woman, it may work for others. Like AstraZeneca’s vaccine, Johnson & Johnson’s vaccine appears to be associated with cases of atypical thrombosis. Despite the occurrence of these rare cases of thrombosis in persons younger than 50 years, they continue to provide effective protection against Covid-19 and its effects.
References
Clark, R. T., Johnson, L., Billotti, J., Foulds, G., Ketels, T., Heard, K., & Calvello Hynes, E. (2021). Early outcomes of bivalirudin therapy for thrombotic thrombocytopenia and cerebral venous sinus thrombosis after Ad26.COV2.S vaccination: A case report. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2021.04.035
