A 29-year-old male healthcare worker, previously healthy and without prior exposure to heparin, received the ChAdOx1 nCoV-19 adenoviral vector vaccine on March 29. Nine days later, he developed persistent headache and abdominal pain. By day 12, symptoms progressed to vomiting and severe abdominal cramps. On day 14, he was admitted urgently due to worsening headache and hematemesis. Laboratory findings revealed profound thrombocytopenia at 32/nL. Gastroscopy demonstrated diffuse gastric mucosal bleeding, indicating significant gastrointestinal hemorrhage. Brain MRI showed complete occlusion of the left transverse and sigmoid sinuses extending into the proximal left jugular vein—diagnostic of cerebral sinus venous thrombosis (Fig. 1a). Abdominal CT angiography confirmed extensive thrombosis involving the portal and mesenteric veins, explaining the source of ongoing bleeding.
Given the temporal association with vaccination, absence of heparin exposure, and presence of multi-system thrombosis with thrombocytopenia, the diagnosis of vaccine-induced immune thrombotic thrombocytopenia (VITT) was strongly suspected.PFKFB4 Antibody Cancer This condition, first reported in early 2021, is characterized by anti-PF4 antibodies that activate platelets and trigger widespread thrombosis [1, 2].HIF2a Antibody Epigenetics Immediate intervention was critical.PMID:35174478 To rapidly neutralize pathogenic antibodies via Fc receptor blockade, high-dose intravenous immunoglobulin (IVIG) therapy was initiated at 1 g/kg body weight on day 1 and day 2 post-admission [3, 4]. Although the platelet count rose only marginally within the first 24 hours, it improved significantly to 98/nL after 48 hours (Fig. 2).
Simultaneously, due to the high risk of fatal hemorrhage from existing thrombi, standard anticoagulation with heparin was contraindicated. Instead, argatroban—a direct thrombin inhibitor—was started immediately following the first IVIG dose. Its short half-life and suitability for continuous infusion made it ideal for managing severe, life-threatening thrombosis in a bleeding-prone patient [5]. Anticoagulant intensity was monitored through frequent PTT measurements, maintained at 1.5 times baseline (50–60 seconds) (Fig. 2).
During the first night in the neurology unit, after receiving 90 g of IVIG, the patient suffered two consecutive epileptic seizures. A non-contrast head CT revealed a new left temporo-parietal intracranial hemorrhage (Fig. 1c), likely secondary to venous congestion from impaired drainage. The patient subsequently developed moderate aphasia and apraxia, necessitating initiation of antiepileptic drugs.
After the second IVIG dose and normalization of platelet counts, D-dimer levels declined sharply—from 65.7 mg/L at presentation to 12.32 mg/L within 48 hours (Fig. 2). With sustained argatroban infusion maintaining a mean PTT of 42 seconds, clinical improvement followed. By day 16, MRI demonstrated progressive recanalization of the transverse and sigmoid sinuses (Fig. 1b), along with resolution of portal and mesenteric vein thromboses. Lactate levels remained normal, and no further abdominal distress occurred.
Confirmatory testing performed days after recovery confirmed PF4-dependent platelet activation in pre-IVIG blood samples, validating the VITT diagnosis [1]. This case illustrates that early administration of high-dose IVIG combined with argatroban-based anticoagulation—without heparin or platelet transfusions—is pivotal in preventing death in severe VITT. Among 16 published cases (11 in Germany and Austria, 5 in Norway), nine patients died. Only those treated promptly with IVIG and avoiding platelet replacement or heparin survived. These findings reinforce a key principle: immediate immune modulation followed by targeted, non-heparin anticoagulation is essential in halting the progression of this deadly syndrome.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com