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Anticoag guidance for patients with CVST or CVT

23 May 2021

New CVT post-vaccine? Treat it like HIT!

By: Matthew Tanner, PharmD, BCPS, clinical coordinator

Patients who received the J&J COVID-19 vaccine (or any adenovirus vector COVID vaccine) can develop Cerebral Venous Sinus with thrombocytopenia. The reason for the pause in vaccination with the J&J vaccine was to determine and disseminate how to treat (especially with anticoagulation) this clotting issue.

Working with Neurology, a guidance document was created for how to treat CVST, with or without thrombocytopenia.

The short version:

  • CVST without thrombocytopenia: therapeutic anticoagulation with enoxaparin (preferred over heparin infusion).
  • CVST with thrombocytopenia & vaccine exposure: therapeutic anticoagulation with fondaparinux, argatroban or bivalirudin.
    • Think of this as “heparin-free HIT” - Heparin Induced Thrombocytopenia
    • Consider IVIg for prolonged platelet non-response.

For more detail, see this link: Anticoagulation for Central Venous Thrombosis (CVT) / Central Venous Sinus Thrombosis (CVST)