Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH

Abstract

The COVID-19 pandemic is an ongoing global healthcare crisis. Based on reports of atypically located thromboses following vaccination with the AstraZeneca COVID-19 vaccine, the Society of Thrombosis and Haemostasis Research (GTH) has issued guidance statements on the recognition, diagnosis, and treatment of this rare complication. It shares pathophysiological features with heparin-induced thrombocytopenia (HIT) and is referred to as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).

Recognizing, managing and reporting vaccine-induced immune thrombotic thrombocytopenia

“…A complete blood cell count should be ordered for any patient for whom there is a suspicion of VITT. [6][7][8][9] Thrombocytopenia and thrombosis in a patient who received a viral vector vaccine within the previous 30 days markedly increases COMMENTARY the probability of VITT. D-dimer and fibrinogen levels can help clinicians to assess for evidence of coagulation consumption.…”

“…It is theoretically possible that heparin will exacerbate VITT because VITT antibodies may react with circulating PF4-heparin complexes. [1][2][3][4][5][6][7][8][10][11][12] Therefore, thrombosis should instead be managed with nonheparin anticoagulants, such as argatroban, fondaparinux or a direct oral anticoagulant. Management is made more challenging if the VITT-associated thrombosis is complicated by hemorrhage, particularly for patients with cerebral venous sinus thrombosis or stroke.…”

“…Management is made more challenging if the VITT-associated thrombosis is complicated by hemorrhage, particularly for patients with cerebral venous sinus thrombosis or stroke. 4,8,10 Intravenous immunoglobulin has been used in the treatment of VITT based on previous experience of patients with severe HIT and thrombosis. [2][3][4][5]7,8,12 Intravenous immunoglobulin is believed to neutralize and block the pathogenic action of VITT antibodies, and in so doing, can raise the platelet count.…”

“…4,8,10 Intravenous immunoglobulin has been used in the treatment of VITT based on previous experience of patients with severe HIT and thrombosis. [2][3][4][5]7,8,12 Intravenous immunoglobulin is believed to neutralize and block the pathogenic action of VITT antibodies, and in so doing, can raise the platelet count. Blood samples for HIT tests (ELISA and serotonin-release assays) should be drawn before intravenous immunoglobulin is administered.…”

COVID-19 vaccination in pregnancy

“…health care workers) or who have comorbidities. Recently, rare cases of thrombosis associated with thrombocytopenia have been identified following administration of viral vector COVID-19 vaccines [8]. Given that pregnant women have a higher rate of developing thrombosis than the general population [9], more clinical data in this patient population is warranted.…”