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Corona vaccination: what triggers sinus vein thrombosis?

Status: 04/21/2021 4:00 p.m.

Cerebral vein thrombosis occurred in connection with corona vaccinations with the AstraZeneca agent. What can trigger the side effects?

So far, 48 suspected cases of sinus vein thrombosis have been reported in Germany after vaccinations with the active ingredient from AstraZeneca. With the exception of eight cases, according to the responsible Paul Ehrlich Institute (PEI), women between the ages of 20 and 66 were affected. However, according to the Robert Koch Institute, women were vaccinated with the product more often than men. Nine people died. After a vaccination stop in mid-March, the Standing Vaccination Commission (Stiko) recommends the AstraZeneca drug in Germany only for people over 60 years of age.

Capillary leak syndrome possible further side effect?

The EU Medicines Agency (EMA) is currently examining whether a vaccination with the AstraZeneca vaccine can trigger another disease. In five cases, the so-called capillary leak syndrome occurred in connection with the vaccination. In this very rare vascular disease, the permeability of the capillary vessels is too high, so that plasma escapes and edema and a drop in blood pressure can occur.

Thrombosis: vaccine can trigger defense mechanisms

Doctors from Greifswald have found out what happens in the body with the rare sinus vein thrombosis and how it can be treated. According to this, the vaccine triggers a defense mechanism in some people. Special antibodies could be detected in the blood of those affected.

This happens with a sinus vein thrombosis

In cerebral vein thrombosis, the sinus vein that carries blood from the brain back to the heart becomes blocked. Blood platelets, or thrombocytes, are responsible for this. Usually they seal damage to the blood vessels to stop bleeding. In sinus vein thrombosis, however, platelets stick together without bleeding. This unusual activation of blood platelets also occurs in rare cases after the administration of heparin, a common blood thinner. Those affected develop heparin-induced thrombocytopenia (HIT). Four to five days after the administration of heparin, antibodies are formed that are directed against a specific protein on the blood platelets.

Similar antibodies appear to develop in a few people after vaccination with AstraZeneca. They attach to the platelets and activate them. Clots form, which in the worst case scenario can clog the vessel.

Vector apparently not a cause of the complication

What triggers this mechanism is still unclear. AstraZeneca is a vector vaccine. He uses harmless adenoviruses as a transporter. Genetic material from the coronavirus is built into it and thus reaches the human cell, where it triggers an immune system reaction. The vaccine from Johnson & Johnson, which will soon be available in Germany and for which there are also indications of thrombosis, and the Russian vaccine Sputnik V are vector vaccines. Experts at Stiko consider it unlikely that the development of sinus vein thrombosis is due to the vector, because then the complication would have to occur much more frequently. It is most likely that those affected have an additional, as yet unknown risk factor.

Birth control pills are also unlikely as a risk factor

It is noticeable that sinus vein thromboses - at least in Germany - mainly occur in younger women. Is it because, unlike in Great Britain, for example, it was mainly younger people who were vaccinated at first? Many of them work in nursing or education, mostly women. Or are there other risk factors that only affect women - such as taking birth control pills? However, experts tend to rule out the birth control pill, because otherwise the number of cases should have been higher.

No special risk for people prone to thrombosis

It is clear that cerebral vein thromboses have nothing in common with the much more common leg vein thromboses. There is therefore no special risk for people who are otherwise prone to thrombosis.

Various symptoms of cerebral vein thrombosis

If a blood clot occurs, the blood builds up in the surrounding vessels and there is a drainage disorder. This can either lead to so-called congestive bleeding or to swelling of the brain. The Standing Vaccination Commission is now warning: Anyone suffering from the following symptoms four to 16 days after vaccination with AstraZeneca should seek medical help immediately:

  • Pain in the corner of the nose and eyes
  • Visual disturbances
  • persistent headache
  • shortness of breath
  • Leg swelling
  • persistent abdominal pain
  • neurological symptoms
  • punctiform skin bleeding

Sinus vein thrombosis: therapy with immunoglobulin and blood thinners

Doctors can use special blood tests to find out if it is a cerebral vein thrombosis that is triggered by antibodies. The good news: if the thrombosis is detected in time, there is therapy. Special immunoglobulins and blood thinners ensure that blood clots dissolve again.

Stiko: benefit of AstraZeneca vaccination higher than risk

The Standing Vaccination Commission currently recommends that the AstraZeneca vaccine only be used for people aged 60 and over until the outstanding questions have been clarified. For them, the benefit of a vaccination that protects against serious illness with Covid-19 is much higher than the risk of isolated cases of cerebral vein thrombosis.

For the time being, Stiko recommends the mRNA vaccines from Biontech / Pfizer and Moderna for the second vaccination for people under 60 years of age who have already been vaccinated with the vaccine from AstraZeneca.

Experts on the subject

Prof. Dr. Christian Bogdan, member of the Standing Vaccination Commission at the Robert Koch Institute
director
Microbiological Institute - Clinical Microbiology, Immunology and Hygiene
university hospital Erlangen
Wasserturmstrasse 3/5
91054 Erlangen
www.mikrobiologie.uk-erlangen.de

Prof. Dr. Andreas Greinacher, Senior Physician
Transfusion Medicine Department
Institute for Immunology and Transfusion Medicine
University Medicine Greifswald
Ferdinand-Sauerbruch-Strasse, 17489 Greifswald
www2.medizin.uni-egoswald.de

Prof. Dr. Florian Langer, specialist in internal medicine, specialist in hematology - internal oncology
Hemostaseology
Coagulation clinic
UKE GmbH ambulance center
University Medical Center Hamburg-Eppendorf
Martinistra├če 52, 20246 Hamburg
www.uke.de

 

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