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Tran HA, Deng L, Wood N, Choi P, Singleton S, Clarke L, Khanlari S, Maitland-Scott I, Bird R, Brown S, Manoharan B, Tan CW, Gold M, Hissaria P, Melody S, Chunilal S SD, Buttery J, Clothier H, Crawford NW, Phuong L, Pepperell D, Effler P, Parker C, Carter N, Macartney K, McStea M, Miller T, Nissen M, Larter C, Kay E, Chen VM. The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 40:100894. [PMID: 37701717 PMCID: PMC10494168 DOI: 10.1016/j.lanwpc.2023.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023]
Abstract
Background Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55-74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305.
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Affiliation(s)
- Huyen A. Tran
- The Alfred Hospital, Melbourne, Victoria, Australia
- Monash Medical Centre, Clayton, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Lucy Deng
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Philip Choi
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sally Singleton
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - Lisa Clarke
- Department of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Sarah Khanlari
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | | | - Robert Bird
- Division of Cancer Services, Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott Brown
- Queensland Health, Brisbane, Queensland, Australia
| | - Bavahuna Manoharan
- Queensland Health, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chee Wee Tan
- Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
- University of Adelaide, South Australia, Australia
| | - Michael Gold
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- Royal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
- University of Adelaide, South Australia, Australia
| | - Shannon Melody
- Public Health Services, Tasmania Department of Health, Hobart, Tasmania, Australia
| | - Sanjeev D. Chunilal S
- Monash Medical Centre, Clayton, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Jim Buttery
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Hazel Clothier
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Centre for Health Analytics, Melbourne Children's Centre, Parkville, Victoria, Australia
| | - Nigel W. Crawford
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Linny Phuong
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | | | - Paul Effler
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Claire Parker
- Western Australian Department of Health, Perth, Western Australia, Australia
| | - Nicola Carter
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Megan McStea
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Todd Miller
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Michael Nissen
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Claire Larter
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Elspeth Kay
- Australian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia
| | - Vivien M. Chen
- Department of Haematology and NSW Health Pathology, Concord Hospital Sydney, New South Wales, Australia
- ANZAC Research Institute, Sydney Local Health District, New South Wales, Australia
- Sydney Medical School, University of Sydney, New South Wales, Australia
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2
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Clarke L, Brighton T, Chunilal SD, Lee CSM, Passam F, Curnow J, Chen VM, Tran HA. Vaccine-induced immune thrombotic thrombocytopenia post dose 2 ChAdOx1 nCoV19 vaccination: Less severe but remains a problem. Vaccine 2023; 41:3285-3291. [PMID: 37085453 DOI: 10.1016/j.vaccine.2023.03.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but established complication of 1st dose ChAdOx1 nCoV19 vaccination (AZD1222), however this complication after dose 2 remains controversial. OBJECTIVES To describe the clinicopathological features of confirmed cases of VITT post dose 2 AZD1222 vaccination in Australia, and to compare this cohort to confirmed cases of VITT post 1st dose. METHODS Sequential cases of clinically suspected VITT (thrombocytopenia, D-Dimer > 5x upper limit normal and thrombosis) within 4-42 days of dose 2 AZD1222 referred to Australia's centralised testing centre underwent platelet activation confirmatory testing in keeping with the national diagnostic algorithm. Final classification was assigned after adjudication by an expert advisory committee. Descriptive statistics were performed on this cohort and comparative analyses carried out on confirmed cases of VITT after 1st and 2nd dose AZD1222. RESULTS Of 62 patients referred, 15 demonstrated presence of antibody mediated platelet activation consistent with VITT after dose 2 AZD1222. Four were immunoassay positive. Median time to presentation was 13 days (range 1-53) platelet count 116x10^9/L (range 63-139) and D-dimer elevation 14.5xULN (IQR 11, 26). Two fatalities occurred. In each, the dosing interval was less than 30 days. In comparison to 1st dose, dose 2 cases were more likely to be male (OR 4.6, 95% CI 1.3-15.8, p = 0.03), present with higher platelet counts (p = 0.05), lower D-Dimer (p = 01) and less likely to have unusual site thromboses (OR 0.14, 95% CI 0.04-0.28, p = 0.02). CONCLUSIONS VITT is a complication of dose 2 AZD1222 vaccination. Whilst clinicopathological features are less severe, fatalities occurred in patients with concomitant factors.
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Affiliation(s)
- Lisa Clarke
- Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, NSW, Australia; Department of Haematology, Concord Repatriation General Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | - Timothy Brighton
- Department of Haematology, Prince of Wales Hospital, Randwick, New South Wales Health Pathology, Sydney, NSW, Australia
| | - Sanjeev D Chunilal
- Department of Clinical Haematology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Christine S M Lee
- ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Freda Passam
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jennifer Curnow
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Vivien M Chen
- Department of Haematology, Concord Repatriation General Hospital, NSW Health Pathology, Sydney, NSW, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Huyen A Tran
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia; Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria Australia
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3
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Kanack AJ, Padmanabhan A. Vaccine-induced immune thrombotic thrombocytopenia. Best Pract Res Clin Haematol 2022; 35:101381. [PMID: 36494147 PMCID: PMC9467921 DOI: 10.1016/j.beha.2022.101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is primarily a complication of adenoviral vector-based covid-19 vaccination. In VITT, thrombocytopenia and thrombosis mediated by anti-platelet factor 4 (PF4) antibodies can be severe, often characterized by thrombosis at unusual sites such as the cerebral venous sinus and splanchnic circulation. Like in heparin-induced thrombocytopenia (HIT) and spontaneous HIT, VITT antibodies recognize PF4-polyanion complexes and activate PF4-treated platelets but additionally bind to un-complexed PF4, a critical finding that could be leveraged for more specific detection of VITT. Intravenous immunoglobulin and non-heparin-based anticoagulation remain the mainstay of treatment. Second dose/boosters of mRNA covid-19 vaccines appear safe in patients with adenoviral vector-associated VITT. Emerging data is consistent with the possibility that ultra-rare cases of VITT may be seen in the setting of mRNA and virus-like particle (VLP) technology-based vaccinations and until more data is available, it is prudent to consider VITT in the differential diagnosis of all post-vaccine thrombosis and thrombocytopenia reactions.
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Affiliation(s)
- Adam J Kanack
- Division of Experimental Pathology, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Anand Padmanabhan
- Divisions of Hematopathology, Transfusion Medicine & Experimental Pathology, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States.
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4
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Bokel J, Mendes-de-Almeida DP, Martins-Gonçalves R, Palhinha L, Vizzoni AG, Correa DF, Brandão LGP, Bozza PT, Grinsztejn B. Generalized Edema and Pseudothrombocytopenia After ChAdOx1 nCoV-19 COVID-19 Vaccination: A Case Report. Front Public Health 2022; 10:907652. [PMID: 35692333 PMCID: PMC9184712 DOI: 10.3389/fpubh.2022.907652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Reports of side effects of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasing worldwide. Capillary leak syndrome and vaccine-induced immune thrombotic thrombocytopenia are very rare but life-threatening adverse events that should be identified early and treated. However, isolated thrombocytopenia can indicate pseudothrombocytopenia. In certain people, ethylenediaminetetraacetic acid (EDTA) induces an in vitro platelet aggregation, resulting in misleading underestimation of platelet counts. It is essential to recognize pseudothrombocytopenia to prevent diagnostic errors, overtreatment, anxiety, and unnecessary invasive procedures. We present a case who developed generalized edema and persistent pseudothrombocytopenia after the first dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca).
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Affiliation(s)
- Joanna Bokel
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Onco-Hematology Unit, Clínica São Vicente, Rio de Janeiro, Brazil
| | - Daniela P. Mendes-de-Almeida
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- *Correspondence: Daniela P. Mendes-de-Almeida
| | - Remy Martins-Gonçalves
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Lohanna Palhinha
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Alexandre G. Vizzoni
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Danusa Ferreira Correa
- Health Surveillance and Immunization Research Unit, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Luciana Gomes Pedro Brandão
- Health Surveillance and Immunization Research Unit, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patrícia T. Bozza
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratory of Clinical Research on STD/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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5
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Krzywicka K, van de Munckhof A, Zimmermann J, Bode FJ, Frisullo G, Karapanayiotides T, Pötzsch B, Sánchez van Kammen M, Heldner MR, Arnold M, Kremer Hovinga JA, Ferro JM, Aguiar de Sousa D, Coutinho JM. Cerebral venous thrombosis due to vaccine-induced immune thrombotic thrombocytopenia after a second ChAdOx1 nCoV-19 dose. Blood 2022; 139:2720-2724. [PMID: 35263427 PMCID: PMC9047988 DOI: 10.1182/blood.2021015329] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but life-threatening complication of adenoviral vaccination against COVID-19, has been reported almost entirely following the first dose. Krzywicka and colleagues report on 124 patients with VITT in a multinational registry diagnosed after dose 2; no specific events were observed after dose 1. These patients had early presentation, and two of the patients died.
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Affiliation(s)
- Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Felix J. Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Theodoros Karapanayiotides
- Second Department of Neurology, School of Medicine and Faculty of Health Sciences, Aristotle University of Thessaloniki, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Johanna A. Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - José M. Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - for the Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Second Department of Neurology, School of Medicine and Faculty of Health Sciences, Aristotle University of Thessaloniki, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece
- Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn, Germany
- Department of Neurology
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal
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6
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7
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Dix C, McFadyen J, Huang A, Chunilal S, Chen V, Tran H. Understanding vaccine-induced thrombotic thrombocytopenia (VITT). Intern Med J 2022; 52:717-723. [PMID: 35446471 PMCID: PMC9111818 DOI: 10.1111/imj.15783] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
Vaccine‐induced thrombotic thrombocytopenia (VITT) is a rare, but serious, syndrome characterised by thrombocytopenia, thrombosis, a markedly raised D‐dimer and the presence of anti‐platelet factor‐4 (PF4) antibodies following COVID‐19 adenovirus vector vaccination. VITT occurs at a rate of approximately 2 per 100 000 first‐dose vaccinations and appears exceedingly rare following second doses. Our current understanding of VITT pathogenesis is based on the observations that patients with VITT have antibodies that bind to PF4 and have the ability to form immune complexes that induce potent platelet activation. However, the precise mechanisms that lead to pathogenic VITT antibody development remain a source of active investigation. Thrombosis in VITT can manifest in any vascular bed and affect multiple sites simultaneously. While there is a predilection for splanchnic and cerebral venous sinus thrombosis, VITT also commonly presents with deep vein thrombosis and pulmonary embolism. Pillars of management include anticoagulation with a non‐heparin anticoagulant, intravenous immunoglobulin and ‘rescue’ therapies, such as plasma exchange for severe cases. VITT can be associated with a high mortality rate and significant morbidity, but awareness and optimal therapy have significantly improved outcomes in Australia. A number of questions remain unanswered, including why VITT is so rare, reasons for the predilection for thrombosis in unusual sites, how long pathological antibodies persist, and the optimal duration of anticoagulation. This review will provide an overview of the presentation, diagnostic workup and management strategies for patients with VITT.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - James McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Angela Huang
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Sanjeev Chunilal
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Vivien Chen
- Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Huyen Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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8
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Chen L, Pavord S. Clinical picture of VITT. Semin Hematol 2022; 59:76-79. [DOI: 10.1053/j.seminhematol.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
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9
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Affiliation(s)
- Joanne Lacy
- UK Health Security Agency, London, United Kingdom
| | - Sue Pavord
- Oxford University, Oxford, United Kingdom
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10
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Roberge G, Carrier M. Persistence of Platelets Activation Prior to Second Doses of Covid-19 Vaccine After Vaccine-Induced Immune Thrombotic Thrombocytopenia. Clin Appl Thromb Hemost 2022; 28:10760296221086283. [PMID: 35275495 PMCID: PMC8919134 DOI: 10.1177/10760296221086283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Guillaume Roberge
- Department of Medicine, 36896Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital Saint-François d'Assise, Québec, Canada
| | - Marc Carrier
- Department of Medicine, 10055Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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