Intracerebral Hemorrhage due to Thrombosis with Thrombocytopenia Syndrome after Vaccination against COVID-19: the First Fatal Case in Korea

"Abstract

Vaccination with an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in the rare development of thrombosis with thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4). This is a life-threatening condition that may be accompanied by bleeding due to thrombocytopenia with thrombosis of the cerebral venous sinus or splanchnic vein. Herein, we describe the first fatal case of thrombosis with thrombocytopenia syndrome in Korea, presenting with intracranial hemorrhage caused by cerebral venous sinus thrombosis... Physicians need to be aware of thrombosis with thrombocytopenia syndrome (TTS) in adenoviral vector-vaccinated patients...

Discussion

... Adenoviral vector SARS-CoV-2 vaccines from AstraZeneca and Janssen have been found to very rarely cause TTS (vaccine-induced immune thrombotic thrombocytopenia). Antibodies related to PF4 induced by adenovector vaccination activate platelets, decrease platelet count, and cause thrombosis. The incidence of TTS appears to be between 1 in 125,000 and 1 in 1,000,000 vaccinated individuals in Europe."