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Symptoms of thrombosis and their diagnostic evaluation in VITT (vaccine-induced immune thrombotic thrombocytopenia)

Site of thrombosis	Typical presenting symptoms	Diagnostic imaging and caveats*
Cerebral veins and dural venous sinuses	New, persistent headache Vomiting Visual impairment Focal neurologic deficits or seizures Encephalopathy	Magnetic resonance venography Conventional angiography Brain MRI (note: CT is often normal and is thus unreliable)
Splanchnic veins (splenic, portal, mesenteric)	Severe abdominal pain Back pain	CT with contrast Doppler ultrasound
DVT of the leg	Leg pain Leg swelling/edema	Compression ultrasonography with Doppler
Pulmonary embolism	Acute chest pain Dyspnea	CT pulmonary angiography Ventilation/perfusion (V/Q) scan
Ophthalmic vein thrombosis	Orbital pain Diplopia or vision loss	MRI Magnetic resonance venography
Ischemic stroke	Sudden onset focal neurologic deficit Encephalopathy	Brain MRI and/or head CT CT or magnetic resonance angiography of the head and neck
Acute limb ischemia	Pain Pulseless pallor Neurologic deficits (sensory or motor)	CT angiography Catheter-based angiography

Additional testing includes CBC with platelet count, anti-PF4 antibody testing (ELISA and/or functional assay), and coagulation testing (PT, aPTT, fibrinogen, and D-dimer).

VITT: vaccine-induced immune thrombotic thrombocytopenia; MRI: magnetic resonance imaging; CT: computed tomography; DVT: deep vein thrombosis; CBC: complete blood count; PF4: platelet factor 4; ELISA: enzyme-linked immunosorbent assay; PT: prothrombin time; aPTT: activated partial thromboplastin time.
* This is a general guide. Refer to UpToDate for detailed information on associated laboratory testing, interpretation of imaging results, and diagnostic algorithms.

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