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European stroke organization interim expert opinion on cerebral venous thrombosis occurring after SARS-CoV-2 vaccination

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dc.contributor.authorFerro, José
dc.contributor.authorde Sousa, Diana Aguiar
dc.contributor.authorCoutinho, Jonathan M.
dc.contributor.authorMartinelli, Ida
dc.date.accessioned2022-02-03T17:54:36Z
dc.date.available2022-02-03T17:54:36Z
dc.date.issued2021
dc.description© European Stroke Organisation 2021. Article reuse guidelines: sagepub.com/journals-permissionspt_PT
dc.description.abstractSevere cases of cerebral venous thrombosis (CVT) with thrombocytopenia and anti-platelet factor 4 (PF4) antibodies occurring after adenoviral vector anti-SARS-CoV-2 vaccines have been recently reported. We aim to present a guidance document on the diagnosis and treatment of patients presenting with CVT after vaccination against SARS-CoV-2 infection. We reviewed the available evidence which consists on case reports, small case series, expert opinion and analogy with heparin-induced thrombocytopenia (HIT) management. Because of the low level of evidence, this is an interim document, based only on expert opinion consensus. In patients presenting with CVT after being vaccinated against SARS-CoV-2 infection, if there is thrombocytopenia a reliable HIT PF4 Antibody ELISA test should be performed, to confirm vaccine-induced immune thrombotic thrombocytopenia (VITT). In patients with CVT and thrombocytopenia, in whom VITT is suspected or confirmed, heparin (unfractionated or low molecular weight) should be avoided and non-heparin anticoagulants are preferred. If possible, platelet transfusions should be avoided. If the diagnosis of VITT is confirmed or suspected, early intravenous immunoglobulins are indicated. This expert opinion is supported by low quality evidence. It should be periodically updated, or changed to a formal guideline, as new and higher quality evidence is eventually produced. Because of their potential unfavourable clinical course, patients developing symptoms and signs suggestive of CVT after being vaccinated against SARS-CoV-2 virus should undergo urgent clinical and neuroimaging evaluation. In cases of suspected or confirmed VITT, non-heparin anticoagulants should be used, platelet transfusions avoided and intravenous immunoglobulin started early.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationEur Stroke J. 2021 Sep;6(3):CXVI-CXXIpt_PT
dc.identifier.doi10.1177/23969873211030842pt_PT
dc.identifier.eissn2396-9881
dc.identifier.issn2396-9873
dc.identifier.urihttp://hdl.handle.net/10451/51106
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSagept_PT
dc.relation.publisherversionhttps://journals.sagepub.com/home/esopt_PT
dc.subjectCOVID-19pt_PT
dc.subjectCerebral venous thrombosispt_PT
dc.subjectHITpt_PT
dc.subjectSARS-CoV-2pt_PT
dc.subjectVITTpt_PT
dc.subjectAnti-platelet antibodiespt_PT
dc.subjectAnticoagulantspt_PT
dc.subjectCerebral venous sinus thrombosispt_PT
dc.subjectImmune-globulinpt_PT
dc.subjectThrombocytopeniapt_PT
dc.subjectVaccinespt_PT
dc.titleEuropean stroke organization interim expert opinion on cerebral venous thrombosis occurring after SARS-CoV-2 vaccinationpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPageCXXIpt_PT
oaire.citation.issue3pt_PT
oaire.citation.startPageCXVIpt_PT
oaire.citation.titleEuropean Stroke Journalpt_PT
oaire.citation.volume6pt_PT
person.familyNameMorão Cabral Ferro
person.familyNameAguiar de Sousa
person.givenNameJosé Manuel
person.givenNameDiana
person.identifier574112
person.identifier.ciencia-id6F16-7E25-7AAF
person.identifier.ciencia-id571C-121A-5CCB
person.identifier.orcid0000-0002-2343-9097
person.identifier.orcid0000-0002-6702-7924
person.identifier.ridJ-4105-2013
person.identifier.scopus-author-id55781226000
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication9a568ce6-d218-44fc-982c-0ffe7bffc197
relation.isAuthorOfPublication1d984575-dd95-4ca1-9092-bf6f9914ba63
relation.isAuthorOfPublication.latestForDiscovery9a568ce6-d218-44fc-982c-0ffe7bffc197

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