Coagulopathies after Vaccination against SARS-CoV-2 May Be Derived from a Combined Effect of SARS-CoV-2 Spike Protein and Adenovirus Vector-Triggered Signaling Pathways

Kircheis, Ralf

doi:10.3390/ijms221910791

Cited by 30 publications

(36 citation statements)

References 139 publications

(216 reference statements)

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“…exsiccosis, thrombocytosis, activation of coagulation) were negative. Anyhow, coagulopathy (hyper- as well as hypo-coagulability) 4 has been repeatedly reported as a complication of SARS-CoV-2 infections/vaccinations. Hypercoagulability is explained by direct activation of platelets, enhancing coagulation, by indirect activation of endothelial cells by SARS-CoV-2, shifting endothelium from an anti-thrombotic to a pro-thrombotic state, by direct activation of complement pathways, promoting thrombin generation, by endothelialitis, and by immune thrombocytopenia with dysfunctional thrombocytes 5 .…”

Section: Discussionmentioning

confidence: 99%

Venous sinus thrombosis after the second jab of an mRNA-based SARS-CoV-2 vaccine

Finsterer

Nics

2022

Brain Hemorrhages

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Objectives Venous sinus thrombosis (VST) after vaccination with the mRNA-based vaccine produced by Pfizer is comparatively rare and usually occurs after the first dose. VST after the second dose has been reported in only few patients. Case report: the patient is a 33yo male who experienced an episode of sudden onset focal, stabbing headache in the left temporal region for about 4h. Three days later a similar episode occurred accompanied by a focal seizure. Twenty days before he had received the second dose of the Pfizer vaccine. Clinical exam was normal but MRI of the brain revealed a VST of the left transverse and sigmoid sinuses. Anticoagulation with low molecular weight heparin followed by dabigatran resulted in complete recovery. Conclusions this case shows that also the second dose of the Pfizer vaccine can be followed by a VST. Currently, there are more arguments in favour of a causal relation between the vaccination and the VST than against it.

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Section: Discussionmentioning

confidence: 99%

Venous sinus thrombosis after the second jab of an mRNA-based SARS-CoV-2 vaccine

Finsterer

Nics

2022

Brain Hemorrhages

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“…But how could the DNA enveloped in the Chadox1 adenovirus capsid be released to bind with PF4? Although Kircheis R et al ( 17 ) pointed out that among the 50 billion virus particles in each dose, some may break apart and release their DNA, then the Ad26.COV2.S vaccine would also have released DNA and caused the same incidence and severity of VITT, which does not accord with the current situation ( 18 ).…”

Section: Five Potential Anionic Substancesmentioning

confidence: 99%

Potential Anionic Substances Binding to Platelet Factor 4 in Vaccine-Induced Thrombotic Thrombocytopenia of ChAdOx1-S Vaccine for SARS-CoV-2

Pang

Liu²,

et al. 2022

Front. Immunol.

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Recent reports of rare ChAdOx1-S vaccine-related venous thrombosis led to the suspension of its usage in several countries. Vaccine-induced thrombotic thrombocytopenia (VITT) is characterized by thrombocytopenia and thrombosis in association with anti-platelet factor 4 (PF4) antibodies. Herein, we propose five potential anionic substances of the ChAdOx1-S vaccine that can combine with PF4 and trigger VITT, including (1) the proteins on the surface of adenovirus, e.g., negative charged glycoprotein, (2) the adjuvant components of the vaccine, e.g., Tween 80, (3) the DNA of adenovirus, (4) the S protein antigen expressed by the vaccine, and (5) the negatively charged impurity proteins expressed by the vaccine, e.g., adenovirus skeleton proteins. After analysis of each case, we consider the most possible trigger to be the negatively charged impurity proteins expressed by the vaccine. Then, we display the possible extravascular route and intravascular route of the formation of PF4 autoantibodies triggered by the negatively charged impurity proteins, which is accordant with the clinical situation. Accordingly, the susceptible individuals of VITT after ChAdOx1-S vaccination may be people who express negatively charged impurity proteins and reach a certain high titer.

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“…Coagulopathies, including thromboses, thrombocytopenia, and other related side effects, are likely correlated to an interplay of the two components in the vaccine, i.e., the spike antigen and the adenoviral vector, with the innate and immune systems, which under certain circumstances can imitate the picture of a limited COVID-19 pathological picture [207,208]. Circulating platelets serve as a reservoir of immunomodulatory molecules [201].…”

Section: Pathophysiological Hypothesesmentioning

confidence: 99%

COVID-19, Vaccines, and Thrombotic Events: A Narrative Review

Abrignani

Murrone

Luca

et al. 2022

JCM

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The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.

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Coagulopathies after Vaccination against SARS-CoV-2 May Be Derived from a Combined Effect of SARS-CoV-2 Spike Protein and Adenovirus Vector-Triggered Signaling Pathways

Cited by 30 publications

References 139 publications

Venous sinus thrombosis after the second jab of an mRNA-based SARS-CoV-2 vaccine

Venous sinus thrombosis after the second jab of an mRNA-based SARS-CoV-2 vaccine

Potential Anionic Substances Binding to Platelet Factor 4 in Vaccine-Induced Thrombotic Thrombocytopenia of ChAdOx1-S Vaccine for SARS-CoV-2

COVID-19, Vaccines, and Thrombotic Events: A Narrative Review

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