Vigilance regarding immune thrombocytopenic purpura after COVID-19 vaccine

Saudagar, Vrushali; Patil, Satish S.; Goh, Shaun; Pothiawala, Sohil

doi:10.1007/s11845-021-02614-2

Cited by 24 publications

(36 citation statements)

References 10 publications

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“…COVID‐19 causes primary or secondary damage to blood vessels. There have been several reports describing immune thrombocytopenic purpura related to COVID‐19 vaccination 1,2 . In HSP, autoimmune memory of vasculitis persists and might be reactivated with COVID‐19 vaccination.…”

Section: Figurementioning

confidence: 99%

Possible HSP reactivation post‐COVID‐19 vaccination and booster

Kondo

Yamanaka

2021

Clinical Case Reports

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Section: Figurementioning

confidence: 99%

Possible HSP reactivation post‐COVID‐19 vaccination and booster

Kondo

Yamanaka

2021

Clinical Case Reports

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“…COVID-19 typically presents with endotheliopathy with microvascular microthrombosis in the lungs, causing ARDS, and occasionally thrombocytopenia, MAHA, and other organ syndromes, which have been called TTP-like syndrome [3,4]. However, vaccine-associated endotheliopathy does not cause TTP-like syndrome, but instead is manifested as "silent" immune thrombocytopenic purpura (ITP) [12,13], which can be called ITP-like syndrome. In addition, CVST [14,15] and multiorgan inflammatory syndrome (MOIS) [16,17] have occurred after vaccination.…”

Section: Endotheliopathymentioning

confidence: 99%

Vaccine-Associated Thrombocytopenia and Thrombosis: Venous Endotheliopathy Leading to Venous Combined Micro-Macrothrombosis

Chang

Hawley

2021

Medicina

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Serious vaccine-associated side effects are very rare. Major complications of vaccines are thrombocytopenia and thrombosis in which pathogenetic mechanism is consistent with endotheliopathy characterized by “attenuated” sepsis-like syndrome, leading to the activation of inflammatory and microthrombotic pathway. In the COVID-19 pandemic, acute respiratory distress syndrome caused by microthrombosis has been the major clinical phenotype from the viral sepsis in association with endotheliopathy-associated vascular microthrombotic disease (EA-VMTD), sometimes presenting with thrombotic thrombocytopenic purpura (TTP)-like syndrome. Often, venous thromboembolism has coexisted due to additional vascular injury. In contrast, clinical phenotypes of vaccine complication have included “silent” immune thrombocytopenic purpura (ITP-like syndrome), multiorgan inflammatory syndrome, and deep venous thrombosis (DVT), cerebral venous sinus thrombosis (CVST) in particular. These findings are consistent with venous (v) EA-VMTD. In vEA-VMTD promoted by activated complement system following vaccination, “consumptive” thrombocytopenia develops as ITP-like syndrome due to activated unusually large von Willebrand factor (ULVWF) path of hemostasis via microthrombogenesis. Thus, the pathologic phenotype of ITP-like syndrome is venous microthrombosis. Myocarditis/pericarditis and other rare cases of inflammatory organ syndrome are promoted by inflammatory cytokines released from activated inflammatory pathway, leading to various organ endotheliitis. Vaccine-associated CVST is a form of venous combined “micro-macrothrombosis” composed of binary components of “microthrombi strings” from vEA-VMTD and “fibrin meshes” from vaccine-unrelated incidental vascular injury perhaps such as unreported head trauma. This mechanism is identified based on “two-path unifying theory” of in vivo hemostasis. Venous combined micro-macrothrombosis due to vaccine is much more serious thrombosis than isolated distal DVT made of macrothrombus. This paradigm changing novel concept of combined micro-macrothrombosis implies the need of combined therapy of a complement inhibitor and anticoagulant for CVST and other complex forms of DVT.

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“…While no causal mechanism has been convincingly identified for immune thrombocytopaenia following COVID-19 vaccination, molecular mimicry appears to be a plausible potential mechanism. [31] The association of the Oxford-AstraZeneca vaccine with immune thrombocytopaenia has been widely reported upon. [32] This may induce a degree of misattribution bias and even misdiagnosis (since in approx.…”

Section: Immune Thrombocytopaeniamentioning

confidence: 99%

A case-control study of autoimmune AEFIs following COVID-19 vaccination reported to VAERS

Csefalvay¹

2021

Preprint

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Autoimmune adverse effects following immunisation (AEFIs) are widely regarded as a chief concern driving vaccine hesitancy. This case-control study seeks to shed light on the true risk of autoimmune AEFIs associated with the COVID-19 vaccine through a case-control analysis of VAERS reports. Reports of autoimmune aetiology were matched with reports of non-autoimmune controls. Statistical analysis reveals that the safety profile of COVID-19 vaccines with regard to autoimmune AEFIs is highly favourable. In particular, neuroautoimmune AEFIs have statistically significant reporting odds ratios below unity (Guillain-Barre syndrome: 0.35, multiple sclerosis: 0.70, transverse myelitis: 0.79), indicating a reduced association of reports of these conditions with the COVID-19 vaccine versus other vaccines. Only three autoimmune aetiologies exceed a ROR of 2.0 and thus present a potential signal. Of these, myasthenia gravis (ROR = 3.90, p < 0.001, 95% CI: 2.63-5.80) may be the result of epidemiological confounding factors not sufficiently controlled by matching, as the population most likely to develop myasthenia gravis was strongly prioritised in the COVID-19 vaccine's initial rollout. Immune thrombocytopaenia (ROR = 26.83, p < 0.001, 95% CI: 16.93-42.54) is a clear safety signal, confirming a large number of case reports and studies that indicate a risk of immune thrombocytopaenic events following the COVID- 19 vaccine. The lone strong safety signal of immune thrombocytopaenia notwithstanding, this study attests to the safety of the COVID-19 vaccine where autoimmune conditions are concerned. Through quantifying the risk of autoimmune disorders associated with COVID-19 vaccination, this study contributes to a growing body of evidence supporting the safety of such vaccines.

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Vigilance regarding immune thrombocytopenic purpura after COVID-19 vaccine

Cited by 24 publications

References 10 publications

Possible HSP reactivation post‐COVID‐19 vaccination and booster

Possible HSP reactivation post‐COVID‐19 vaccination and booster

Vaccine-Associated Thrombocytopenia and Thrombosis: Venous Endotheliopathy Leading to Venous Combined Micro-Macrothrombosis

A case-control study of autoimmune AEFIs following COVID-19 vaccination reported to VAERS

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