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Acute ST-segment elevation myocardial infarction secondary to vaccine-induced immune thrombosis with thrombocytopaenia (VITT).
Flower, Luke; Bares, Zdenek; Santiapillai, Georgina; Harris, Stephen.
  • Flower L; Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK luke.flower@doctors.org.uk.
  • Bares Z; William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK.
  • Santiapillai G; Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK.
  • Harris S; Haematology Department, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Case Rep ; 14(9)2021 Sep 27.
Article in English | MEDLINE | ID: covidwho-1440813
ABSTRACT
A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24×109 µg/L) and a raised d-dimer (>110 000 µg/L), and he was urgently transferred to our tertiary referral central for suspected vaccine-induced immune thrombocytopaenia and thrombosis (VITT). He developed dynamic ischaemic electrocardiographic changes with ST elevation, a troponin of 3185 ng/L, and regional wall motion abnormalities. An occlusion of his left anterior descending coronary artery was seen on CT coronary angiography. His platelet factor-4 (PF-4) antibody returned strongly positive. He was urgently treated for presumed VITT with intravenous immunoglobulin, methylprednisolone and plasma exchange, but remained thrombocytopaenic and was initiated on rituximab. Argatroban was used for anticoagulation for his myocardial infarction while he remained thrombocytopaenic. After 6 days, his platelet count improved, and his PF-4 antibody level, troponin and d-dimer fell. He was successfully discharged after 14 days.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Vaccines / Purpura, Thrombocytopenic, Idiopathic / ST Elevation Myocardial Infarction / COVID-19 / Myocardial Infarction Type of study: Case report / Prognostic study Topics: Vaccines Limits: Adult / Humans / Male Language: English Year: 2021 Document Type: Article Affiliation country: Bcr-2021-245218

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Vaccines / Purpura, Thrombocytopenic, Idiopathic / ST Elevation Myocardial Infarction / COVID-19 / Myocardial Infarction Type of study: Case report / Prognostic study Topics: Vaccines Limits: Adult / Humans / Male Language: English Year: 2021 Document Type: Article Affiliation country: Bcr-2021-245218