Tohoku J. Exp. Med., 2022 December, 258(4)

Fatal Cerebral Venous Thrombosis in a Pregnant Woman with Inherited Antithrombin Deficiency after BNT162b2 mRNA COVID-19 Vaccination

Kohei Takikawa,¹ Ryosuke Doijiri,¹ Naoto Kimura,² Ako Miyata,¹ Takuji Sonoda,¹ Naoya Yamazaki,¹ Shuhei Egashira,¹ Kiyotaka Oi,¹ Hiroki Uchida,² Kanako Kato,¹ Momoyo Oda,³ Michiko Yokosawa,² Takahiko Kikuchi,¹ Takayuki Sugawara² and Hiroaki Takahashi¹

¹Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
²Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
³Department of Rehabilitation, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan

Antithrombin deficiency is a high-risk factor for venous thromboembolism during pregnancy, whereas cerebral venous thrombosis is rare. Cerebral venous thrombosis related to coronavirus disease 2019 (COVID-19) vaccines has been reported; however, there are a few reports of cerebral venous thrombosis after a messenger RNA (mRNA) vaccination. 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. She demonstrated heparin resistance and was found to have an inherited antithrombin deficiency. A heterozygous missense variant in SERPINC1 (c.379T>C, p.Cys127Arg, ‘AT Morioka’) 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. Treatment with unfractionated heparin and antithrombin concentrate may be ineffective in severe cerebral venous thrombosis cases with antithrombin deficiency. Early recognition of antithrombin deficiency and an immediate switch to other anticoagulants may be required. Although the association between cerebral venous thrombosis and the vaccine is uncertain, COVID-19 vaccinations may require careful evaluation for patients with prothrombic factors.

Keywords —— antithrombin deficiency; cerebral venous thrombosis; coronavirus disease 2019; messenger RNA vaccine; pregnancy

© 2022 Tohoku University Medical Press

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Tohoku J. Exp. Med 2022, 258, 327-332.

Correspondence: Naoto Kimura, Department of Neurosurgery, Iwate Prefectural Central Hospital, 1-4-1 Ueda, Morioka, Iwate 020-0066, Japan.

e-mail: kmr@themis.ocn.ne.jp