Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination

Muir, Kate Lynn E.; Kallam, Avyakta; Koepsell, Scott A.; Gundabolu, Krishna

doi:10.1056/nejmc2105869

Cited by 369 publications

(329 citation statements)

References 4 publications

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“…Vaccine-induced immune thrombotic thrombocytopenia is a syndrome that was first reported in April 2021 among patients who had recently received the ChAdOx1 nCoV-19 vaccine. [2][3][4][5][6][7] It closely resembles HIT, in which antibodies, typically immunoglobulin G (IgG), are produced against circulating complexes of PF4 and endogenous heparin. [8][9][10] and regulate hemostasis by releasing PF4, a 70-amino acid protein that binds heparin.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 They show that patients with VITT can present with a wide range of thrombotic events and they do not identify any age or gender diagnostic criteria. Two recent reports also describe VITT among patients who received the Ad26.COV2.S vaccine (Johnson & Johnson-Janssen); 6,16 the International Society on Thrombosis and Hemostasis identifies both vaccines that use adenovirus vectors (ChAdOx1 nCoV-19 and Ad26.COV2.S) as potential triggers of VITT. 15…”

Section: Discussionmentioning

confidence: 99%

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Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia

Jones

Boisvert

Landry

et al. 2021

CMAJ

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63-year-old man presented to the emergency department with a 5-day history of a cool, painful lef leg, new onset of paresthesia of the lef leg and foot, and severe shortness of breath. The patient had no personal or family history of thrombotic events and no personal history or symptoms of arrythmia. He was a nonsmoker with no symptoms or prior documentation of peripheral vascular, coronary or cerebrovascular disease. He had a history of obesity and hypertension controlled with a single agent. Two rapid point-of-care tests were negative for SARS-CoV-2 earlier on the day of presentation (Abbott ID NOW isothermal nucleic acid test). The patient had received his first dose of the ChAdOx1 nCoV-19 vaccine 20 days before the onset of his symptoms.Upon presentation, we noted that the patient was obese (body mass index 41.8) and hypoxic (oxygen saturation 85% on room air, normal > 90%). His lef foot was cold, pale and insensate, with decreased motor function and absent arterial Doppler signals (Rutherford IIB acute limb ischemia). 1 Laboratory investigations showed thrombocytopenia (platelets 36 [normal 150-400] × 10 9 /L), D-Dimer > 10 000 (normal ≤ 50) ng/mL fibrinogenequivalent units, fibrinogen 1.4 (normal 1.6-4.1) g/L and international normalized ratio 1.3 (normal 0.9-1.1). A computed tomography angiogram showed lef popliteal artery occlusion with no visible tibial vessels, even on delayed imaging. It also showed bilateral segmental pulmonary artery thrombi and thrombus adherent to the wall of the infrarenal aorta (Figure 1).We started therapeutic anticoagulation with intravenous unfractionated heparin. Emergency surgical thrombectomy of the popliteal artery and all tibial arteries yielded a large amount of thrombus. We infused tissue plasminogen activator into the tibial arteries intraoperatively. We obtained good antegrade and retrograde flow, with marked pedal hyperemia and normal triphasic arterial Doppler signals upon reperfusion. Intraoperatively, the patient was intermittently hypoxic, consistent with his substantial pulmonary artery thrombus. KEY POINTS• Vaccine-induced immune thrombotic thrombocytopenia (VITT) must be considered in any patient presenting with thrombosis and thrombocytopenia afer recently receiving a vaccine for SARS-CoV-2 that uses an adenovirus vector (ChAdOx1 nCoV-19 Oxford-AstraZeneca or Ad26.COV2.S Johnson & Johnson-Janssen).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia

Jones

Boisvert

Landry

et al. 2021

CMAJ

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“…An atypical autoimmune HIT may be the consequent event which could amplify platelet activation and coagulation cascade. The rare occurrence of VITT also in patients who received the Ad26.COV2.S vaccine (Johnson & Johnson/Janssen) 5 suggests a possible pathogenic role of the adenoviral viral vector. More investigations are warranted to elucidate this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…S vaccine (Johnson & Johnson/Janssen). 5 A vaccine-induced immune thrombotic thrombocytopenia (VITT) has been suggested to name this new clinical syndrome, in order to distinguish it from the Heparin induced thrombocytopenia (HIT). 2 Pathophysiological mechanisms of post-vaccination PF4-polyanion antibodies induction are still unknown.…”

Section: Introductionmentioning

confidence: 99%

Malignant cerebral infarction, systemic venous thrombosis and thrombocytopenia after ChAdOx1 nCov vaccination: a possible catastrophic variant of vaccine induced thrombotic thrombocytopenia

Michele¹,

Iacobucci²,

Nicolini³

et al. 2021

Preprint

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Vaccine induced thrombotic thrombocytopenia is a new syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine and characterized by cerebral venous thrombosis. We report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia within 10 days after vaccination with ChAdOx1 nCoV-19. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both the patients had pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes.

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“…(CVST) associated with thrombocytopenia, in the weeks following vaccine administration 5,6 . All six cases occurred among women between the ages of 18 and 48, a high-risk group for this condition 7 , and symptoms occurred 6 to 13 days after vaccination 8 .…”

Section: Introductionmentioning

confidence: 99%

Cerebral venous sinus thrombosis (CVST) is not significantly linked to COVID-19 vaccines or non-COVID vaccines in a large multi-state US health system

Pawlowski

Rincón-Hekking

Awasthi

et al. 2021

Preprint

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Cerebral venous sinus thrombosis (CVST) has been reported in a small number of individuals who have received the mRNA vaccines1 or the adenoviral vector vaccines for COVID-19 in the US2 and Europe3. Continued pharmacovigilance is integral to mitigating the risk of rare adverse events that clinical trials are underpowered to detect, however, these anecdotal reports have led to the pause or withdrawal of some vaccines in many jurisdictions and exacerbated vaccine hesitancy at a critical moment in the fight against the COVID-19 pandemic. We investigated the frequencies of CVST seen among individuals who received FDA-authorized COVID-19 vaccines from Pfizer-BioNTech (n = 94,818 doses), Moderna (n = 36,350 doses) and Johnson & Johnson - J&J (n = 1,745 doses), and among individuals receiving one of 10 FDA-approved non-COVID-19 vaccines (n = 771,805 doses). Comparing the incidence rates of CVST in 30-day time windows before and after vaccination, we found no statistically significant differences for the COVID-19 vaccines or any other vaccines studied in this population. In total, we observed 3 cases of CVST within the 30 days following Pfizer-BioNTech vaccination (2 females, 1 male; Ages (years): [79, 80, 84]), including one individual with a prior history of thrombosis and another individual with recent trauma in the past 30 days. We did not observe any cases of CVST among the patients receiving Moderna or J&J vaccines in this study population. We further found the baseline CVST incidence in the study population between 2017 and 2021 to be 45 to 98 per million patient years. Overall, this real-world evidence-based study highlights that CVST is rare and is not significantly associated with COVID-19 vaccination. In addition, there is a need for a concerted international effort to monitor EHR data across diverse patient populations and to investigate the underlying biological mechanisms leading to these rare clotting events.

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Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination

Cited by 369 publications

References 4 publications

Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia

Limb ischemia and pulmonary artery thrombosis after the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia

Malignant cerebral infarction, systemic venous thrombosis and thrombocytopenia after ChAdOx1 nCov vaccination: a possible catastrophic variant of vaccine induced thrombotic thrombocytopenia

Cerebral venous sinus thrombosis (CVST) is not significantly linked to COVID-19 vaccines or non-COVID vaccines in a large multi-state US health system

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