"Abstract
... A 25-year-old female in her sixth week of pregnancy presented with headache 24 days after BNT162b2 mRNA COVID-19 vaccination. The following day, she presented with altered sensorium and was diagnosed with severe cerebral venous thrombosis [CVT]. She demonstrated heparin resistance and was found to have an inherited antithrombin deficiency. A heterozygous missense variant in SERPINC1 [gene]... was detected by DNA analysis. Despite intensive care with unfractionated heparin, antithrombin concentrate, and repeated endovascular treatments, she died on the sixth day of hospitalization. Cerebral venous thrombosis in pregnant women with an antithrombin deficiency can follow a rapid and fatal course...
Discussion
... The pathophysiology of this disease has not been clarified, and it is uncertain whether and how an mRNA vaccine contributed to the development of CVT in our case... The unknown mechanisms of thrombogenicity due to mRNA vaccination possibly contributed to the development of CVT. COVID-19 vaccination may require careful evaluation in patients with prothrombic factors...
Our case highlights the difficulty in the management of severe CVT in a pregnant patient with AT deficiency. Treatment with UFH [unfractionated heparin] and AT concentrate may be ineffective in severe CVT cases with AT deficiency. Early recognition of AT deficiency and an immediate switch to other anticoagulants may be required."
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