Case 147 – Update 2

We have a 34 year-old female patient presenting with headache, thrombocytopenia (plt 25) and intracranial haemorrhage requiring a decompressive craniectomy. She had the ChAdOx1 nCoV-19 (AstraZeneca) vaccine 13 days ago.

D-dimers are significantly elevated at 35,283 and subsequent CT venogram has confirmed significant sigmoid sinus thrombosis. Anti-PF4 antibodies have been sent but will take a few days to come back.

There is high clinical suspicion of Vaccine-Induced Immune Thrombocytopenia and Thrombosis (VITT).

The patient is stable and the neurosurgeons are happy to commence anticoagulation.

What anticoagulant would you use, if any?

What other treatment would you implement, if any?

Why would the anti-PF4 ELISA be positive in the absence of heparin?!

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