Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination

Bayas, Antonios; Menacher, Martina; Christ, Monika; Behrens, Lars; Rank, Andreas; Naumann, Markus

doi:10.1016/s0140-6736(21)00872-2

Cited by 117 publications

(130 citation statements)

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“…Finally, several international reports have been published highlighting the possibility of thrombohemorrhagic complications within the time interval of 5 to 16 days after the first dose of the adenoviral vector vaccine ChAdOx1-19 against COVID-19 [7][8][9]18]: these data confirmed that the analyzed cases may be definitively classified as AEFI caused by vaccination.…”

Section: Ihc Findings (Figure 3)mentioning

confidence: 52%

“…Moreover, in order to develop specific evidence-based items, an exhaustive review of the pertinent literature was performed. To date, several reports have been published reporting severe adverse effects (thrombosis and thrombocytopenia) after COVID-19 vaccination [7][8][9][16][17][18][19]. Each report was analyzed independently by each author of this article in order to identify specific items.…”

Section: Vaccine Characteristics and Exhaustive Review Of The Literaturementioning

confidence: 99%

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COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis

et al. 2021

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The current challenge worldwide is the administration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Even if rarely, severe vascular adverse reactions temporally related to vaccine administration have induced diffidence in the population at large. In particular, researchers worldwide are focusing on the so-called “thrombosis and thrombocytopenia after COVID-19 vaccination”. This study aims to establish a practical workflow to define the relationship between adverse events following immunization (AEFI) and COVID-19 vaccination, following the basic framework of the World Health Organization (WHO). Post-mortem investigation plays a pivotal role to support this causality relationship when death occurs. To demonstrate the usefulness and feasibility of the proposed workflow, we applied it to two exemplificative cases of suspected AEFI following COVID-19 vaccination. Based on the proposed model, we took into consideration any possible causality relationship between COVID-19 vaccine administration and AEFI. This led us to conclude that vaccination with ChAdOx1 nCov-19 may cause the rare development of immune thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4), which clinically mimics heparin-induced autoimmune thrombocytopenia. We suggest the adoption of the proposed methodology in order to confirm or rule out a causal relationship between vaccination and the occurrence of AEFI.

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Section: Ihc Findings (Figure 3)mentioning

confidence: 52%

Section: Vaccine Characteristics and Exhaustive Review Of The Literaturementioning

confidence: 99%

COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis

et al. 2021

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“…Cases of thrombotic thrombocytopenia induced by coronavirus disease 2019 (COVID-19) vaccines have been reported recently [1][2][3]. Herein, we describe the first case of another critical disorder, hemophagocytic lymphohistiocytosis (HLH), in a healthy person after COVID-19 vaccination.…”

Section: To the Editormentioning

confidence: 94%

Hemophagocytic lymphohistiocytosis after COVID-19 vaccination

Tang

2021

J Hematol Oncol

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Cases of thrombotic thrombocytopenia induced by coronavirus disease 2019 (COVID-19) vaccines have been reported recently. Herein, we describe the first case of another critical disorder, hemophagocytic lymphohistiocytosis (HLH), in a healthy individual after COVID-19 vaccination. A 43-year-old Chinese farmer developed malaise, vomiting, and persistent high fever (up to 39.7 °C) shortly after receiving the first dose of the inactivated SARS-CoV-2 vaccine. The initial evaluation showed pancytopenia (neutrophil count, 0.70 × 109/L; hemoglobin, 113 g/L; platelet, 27 × 109/L), elevated triglyceride (2.43 mmol/L), and decreased fibrinogen (1.41 g/L). Further tests showed high serum ferritin levels (8140.4 μg/L), low NK cell cytotoxicity (50.13%–60.83%), and positive tests for Epstein–Barr virus (EBV) DNA. Hemophagocytosis was observed in the bone marrow. Therefore, HLH was confirmed, and dexamethasone acetate (10 mg/day) was immediately prescribed without etoposide. Signs and abnormal laboratory results resolved gradually, and the patient was discharged. HLH is a life-threatening hyperinflammatory syndrome caused by aberrantly activated macrophages and cytotoxic T cells, which may rapidly progress to terminal multiple organ failure. In this case, HLH was induced by the COVID-19 vaccination immuno-stimulation on a chronic EBV infection background. This report indicates that it is crucial to exclude the presence of active EBV infection or other common viruses before COVID-19 vaccination.

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“…The presentation window after vaccination may span a broader time range that reported in the original case series, especially when underlying thrombotic events lead to milder, less acute clinical manifestations hence leading to delayed diagnosis. Furthermore, a non-specific, flu-like illness may precede or accompany the syndrome at the time of presentation [ 31 ]. A presumptive diagnosis of VITT is confirmed with the demonstration of circulating PF4/polyanion antibodies (usually with high optical density readings [ 1 , 2 ]) via enzyme-linked immunosorbent assay (ELISA), in the absence of prior heparin exposure.…”

Section: Diagnostic and Therapeutic Considerationsmentioning

confidence: 99%

Vaccine induced thrombotic thrombocytopenia: The shady chapter of a success story

2021

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The recognition of the rare but serious and potentially lethal complication of vaccine induced thrombotic thrombocytopenia (VITT) raised concerns regarding the safety of COVID-19 vaccines and led to the reconsideration of vaccination strategies in many countries. Following the description of VITT among recipients of adenoviral vector ChAdOx1 vaccine, a review of similar cases after Ad26.COV2·S vaccination gave rise to the question whether this entity may constitute a potential class effect of all adenoviral vector vaccines. Most cases are females, typically younger than 60 years who present shortly (range: 5–30 days) following vaccination with thrombocytopenia and thrombotic manifestations, occasionally in multiple sites. Following initial incertitude, concrete recommendations to guide the diagnosis (clinical suspicion, initial laboratory screening, PF4-polyanion-antibody ELISA) and management of VITT (non-heparin anticoagulants, corticosteroids, intravenous immunoglobulin) have been issued. The mechanisms behind this rare syndrome are currently a subject of active research and include the following: 1) production of PF4-polyanion autoantibodies; 2) adenoviral vector entry in megacaryocytes and subsequent expression of spike protein on platelet surface; 3) direct platelet and endothelial cell binding and activation by the adenoviral vector; 4) activation of endothelial and inflammatory cells by the PF4-polyanion autoantibodies; 5) the presence of an inflammatory co-signal; and 6) the abundance of circulating soluble spike protein variants following vaccination. Apart from the analysis of potential underlying mechanisms, this review aims to synopsize the clinical and epidemiologic features of VITT, to present the current evidence-based recommendations on diagnostic and therapeutic work-up of VITT and to discuss new dilemmas and perspectives that emerged after the description of this entity.

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Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination

Cited by 117 publications

References 0 publications

COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis

COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis

Hemophagocytic lymphohistiocytosis after COVID-19 vaccination

Vaccine induced thrombotic thrombocytopenia: The shady chapter of a success story

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