Immune thrombocytopenia in 2 healthy young women after the Pfizer-BioNTech BNT16B2b2 messenger RNA coronavirus disease 2019 vaccination

A Systematic Review of Vascular Injuries: A Review of Petechiae, Purpura, and Ecchymosis in Critical Situations Following COVID-19 Vaccination

Background and Aims

Vascular injuries characterized by petechiae, purpura, and ecchymosis have been reported as potential adverse effects following COVID-19 vaccination. This study aims to identify the characteristics of patients experiencing vascular injuries postvaccination and to outline key clinical considerations.

Methods

A systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of Scopus, Web of Science, and PubMed/MEDLINE databases was performed for English-language publications up to July 2024. Eligible studies included reports of vascular injuries following COVID-19 vaccination.

Results

Of the 1064 articles retrieved, 35 studies met the inclusion criteria. The majority of cases presented symptoms after receiving the first doses of Pfizer-BioNTech, Moderna, AstraZeneca, and Janssen vaccines. Diagnosed conditions included thrombotic thrombocytopenic purpura (TTP), immune thrombocytopenic purpura (ITP), vasculitis, and acquired hemophilia A. None of the patients tested positive for SARS-CoV-2 at the time of diagnosis. The most commonly affected sites were the lower extremities, with petechiae, purpura, and ecchymosis being the predominant manifestations.

Conclusion

Our findings suggest a possible but unconfirmed association between COVID-19 vaccination and the development of vascular injuries, including petechiae, purpura, and ecchymosis. These symptoms may serve as early indicators of critical conditions requiring urgent medical intervention. Further research and postvaccination monitoring are necessary to establish causality and assess potential risk factors.