Vaccine-induced thrombotic
thrombocytopenia is a newly described disease process in the setting of expanding access to
COVID-19 vaccination. The United States Centers for Disease Control and Prevention recommends treatment with an alternative to
heparin in patients suspected of having
vaccine-induced thrombotic
thrombocytopenia. At this time there have been no reported outcomes from the treatment of
vaccine-induced thrombotic
thrombocytopenia with
bivalirudin as a
heparin alternative. We describe the early outcomes from the treatment of
vaccine-induced thrombotic
thrombocytopenia with
bivalirudin as a
heparin alternative. A 40-year-old Caucasian woman was found to have
thrombocytopenia, cerebral venous
sinus thrombosis, and
pulmonary embolism following vaccination for
COVID-19 with
Ad26.COV2.S. She exhibited a steady rise in platelet count: 20×109/L at hospital day 0, 115×109/L at discharge on hospital day 6, and 182×109/L on outpatient follow-up on day 9. While the patient exhibited a transient drop in
hemoglobin, there was no clinical evidence of
bleeding. This patient did not demonstrate any clinical sequelae of
thrombosis, and she reported resolution of her
headache. Vaccination with Ad26.COV2.S appears to be associated with a small but significant risk for thrombotic
thrombocytopenia within 13 days of receipt. The Centers for Disease Control and Prevention guidance to consider an alternative to
heparin was not accompanied by specifically recommended alternatives. A single patient treated with
bivalirudin for suspected
vaccine-induced thrombotic
thrombocytopenia subsequently experienced symptom improvement and a rise in platelet count and did not demonstrate any immediate negative outcomes. A provider may consider
bivalirudin as an alternative to
heparin in patients with suspected
vaccine-induced thrombotic
thrombocytopenia following
Ad26.COV2.S vaccination, pending more definitive research.