新冠疫苗引起免疫血栓性血小板低下症合併腦靜脈竇栓塞－診斷與治療

Abstract

台灣自5月新冠疫情爆發以來，民眾陸續接種疫苗；但隨之而來的疫苗副作用患者湧現全台急診室；其中，腦靜脈竇栓塞為新冠疫苗引起的免疫血栓性血小板低下症之一，少見但發生在育齡女性最多。這篇研究主要參考國外文獻，如何診斷及治療疫苗後腦靜脈竇栓塞，建立簡潔明瞭流程圖。研究發現，AZ疫苗產生免疫血栓性血小板低下症為最多，發生時間為疫苗後5-24天內；腦靜脈竇栓塞占此病症多數，以小於60歲的女性患病為大宗。診斷以臨床症狀及影像為主，病患會出現頭痛、神經學異常甚至癲癇；最精確的影像診斷為核磁共振靜脈造影。抗凝血劑的治療降低靜脈血流壓力進而減少腦出血機率，改善病人預後。如果病人打完疫苗1個月內，出現嚴重頭痛、神經學異常，合併血小板下降、D-dimer上升，佐以影像學診斷；診斷後給予新型口服抗凝血劑或是進一步以血栓溶解術治療。  Background and Purpose: Since COVID-19 pandemic outbreaks on May in Taiwan this year, people have received vaccination in succession. However, patients suffered from side effects flocked to emergent department. Cerebral venous sinus thrombosis(CVST), one of Vaccine Induced Immune Thrombotic Thrombocytope-nia(VITT),is a rare form of cerebrovascular disease that typically affects young women of childbearing age. This article is aimed to summarize flow chart for diagno-sis and treatment of CVST to help patients in ED. Methods: We use key words” COVID-19 Vaccine” and “Cerebral Venous Sinus Thrombosis” in PubMed and total 49 full text papers in recent 5 years, which we concluded the diagnosis and treatment and finally 21 papers as reference for this article. Results: VITT occurs at a 4-fold higher frequency with AstraZeneca vaccine. The most common thrombotic event as-sociated with VITT is CVST. The diagnosis of CVST is typically based on clinical suspicion and imaging confirmation. Magnetic resonance venogram (MRV) is the most preferred diagnostic modality for CVST. Patients have a favorable clinical outcome with anticoagulant therapy. Conclusions: Patient appeared severe headache, neurological deficit within 1 month after vaccination added to decreased platelet count ,elevated D-dimer. Image test can confirm the diagnosis. New oral anticoagu-lants (NOACs), endovascular thrombolysis are choices of treatment.