Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines
- PMID:34062319
- PMCID: PMC8143907
- DOI: 10.1016/j.ajem.2021.05.054
Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines
Abstract
Background: Current vaccines for the Coronavirus Disease of 2019 (COVID-19) have demonstrated efficacy with low risk of adverse events. However, recent reports of thrombosis with thrombocytopenia syndrome (TTS) associated with adenovirus vector vaccines have raised concern.
Objective: This narrative review summarizes the current background, evaluation, and management of TTS for emergency clinicians.
Discussion: TTS, also known as vaccine-induced immune thrombotic thrombocytopenia, is a reaction associated with exposure to the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) and AD26.COV2·S (Johnson & Johnson) vaccine, which may result in thrombocytopenia and thrombotic events. There are several case series of patients diagnosed with TTS, but the overall incidence is rare. TTS is characterized by exposure to one of the aforementioned vaccines 4-30 days prior to presentation, followed by thrombosis, mild-to-severe thrombocytopenia, and a positive platelet factor-4 (PF4)-heparin enzyme-linked immunosorbent assay (ELISA). Thrombosis typically involves atypical locations, including cerebral venous thrombosis and splanchnic vein thrombosis. Evaluation should include complete blood count, peripheral smear, D-dimer, fibrinogen, coagulation panel, renal and liver function, and electrolytes, as well as PF4-heparin ELISA if available. Consultation with hematology is recommended if suspected or confirmed. Treatment may include intravenous immunoglobulin and anticoagulation, while avoiding heparin-based agents and platelet transfusion.
Conclusions: With increasing vaccine distribution, it is essential for emergency clinicians to be aware of the evaluation and management of this condition.
Keywords: COVID-19; Coronavirus; Infectious disease; TTS; Thrombosis with thrombocytopenia syndrome; VITT; Vaccine; Vaccine-induced immune thrombotic thrombocytopenia.
Published by Elsevier Inc.
Comment in
- The conundrum of thrombosis with thrombocytopenia syndrome following COVID-19 vaccines.Kounis NG, Koniari I, Kouni SN, Mplani V, Plotas P, Velissaris D.Kounis NG, et al.Am J Emerg Med. 2022 Jul;57:156-157. doi: 10.1016/j.ajem.2022.04.019. Epub 2022 Apr 21.Am J Emerg Med. 2022.PMID:35489990Free PMC article.No abstract available.
- Vaccine-induced immune thrombotic thrombocytopenia: why, what, who, and how?Long B, Bridwell R, Gottlieb M.Long B, et al.Am J Emerg Med. 2022 Jul;57:158-159. doi: 10.1016/j.ajem.2022.04.020. Epub 2022 Apr 25.Am J Emerg Med. 2022.PMID:35501201Free PMC article.No abstract available.
Similar articles
- COVID-19 vaccines and thrombosis with thrombocytopenia syndrome.Lai CC, Ko WC, Chen CJ, Chen PY, Huang YC, Lee PI, Hsueh PR.Lai CC, et al.Expert Rev Vaccines. 2021 Aug;20(8):1027-1035. doi: 10.1080/14760584.2021.1949294. Epub 2021 Jul 8.Expert Rev Vaccines. 2021.PMID:34176415Review.
- Retrospective review COVID-19 vaccine induced thrombotic thrombocytopenia and cerebral venous thrombosis-what can we learn from the immune response.Franceschi AM, Petrover DR, McMahon TM, Libman RB, Giliberto L, Clouston SAP, Castillo M, Kirsch C.Franceschi AM, et al.Clin Imaging. 2022 Oct;90:63-70. doi: 10.1016/j.clinimag.2022.06.020. Epub 2022 Jul 15.Clin Imaging. 2022.PMID:35926315Free PMC article.
- Multiple Electrode Aggregometry (Multiplate): Functional Assay for Vaccine-Induced (Immune) Thrombotic Thrombocytopenia (VITT).Kong Y, Kershaw G, Fu YKS, Passam F.Kong Y, et al.Methods Mol Biol. 2023;2663:429-440. doi: 10.1007/978-1-0716-3175-1_28.Methods Mol Biol. 2023.PMID:37204728
- Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil.Mouta Nunes de Oliveira P, Mendes-de-Almeida DP, Bertollo Gomes Porto V, Crespo Cordeiro C, Vitiello Teixeira G, Saraiva Pedro R, Roberto Gomes Takey P, Kegele Lignani L, Reis Xavier J, Cardoso Doria da Gama V, Amorim Filho L, Emoingt Furtado B, Santa Maria A, Dahrug Barros T, Neves Waite Freitas L, Dos Santos Pereira T, Lima Abreu D, Bernardes Ramos M, Gabe C, Arnold D, William Smith J, Nazy I, Lourdes de Sousa Maia M; Brazillian VITT Investigative Collaboration Group.Mouta Nunes de Oliveira P, et al.Vaccine. 2022 Aug 5;40(33):4788-4795. doi: 10.1016/j.vaccine.2022.06.014. Epub 2022 Jun 16.Vaccine. 2022.PMID:35779962Free PMC article.
- Cerebral venous sinus thrombosis after adenovirus-vectored COVID-19 vaccination: review of the neurological-neuroradiological procedure.Wittstock M, Walter U, Volmer E, Storch A, Weber MA, Großmann A.Wittstock M, et al.Neuroradiology. 2022 May;64(5):865-874. doi: 10.1007/s00234-022-02914-z. Epub 2022 Feb 19.Neuroradiology. 2022.PMID:35184205Free PMC article.Review.
Cited by
- Autopsy findings of post-COVID-19 vaccination deaths in Tokyo Metropolis, Japan, 2021.Suzuki H, Ro A, Takada A, Saito K, Hayashi K.Suzuki H, et al.Leg Med (Tokyo). 2022 Nov;59:102134. doi: 10.1016/j.legalmed.2022.102134. Epub 2022 Aug 20.Leg Med (Tokyo). 2022.PMID:36037554Free PMC article.
- Map of thrombogenesis in viral infections and viral-driven tumours.Neto BV, Tavares V, Santos JMO, Cerqueira F, Pereira D, Medeiros R.Neto BV, et al.Discov Oncol. 2023 Jan 8;14(1):3. doi: 10.1007/s12672-022-00610-1.Discov Oncol. 2023.PMID:36617364Free PMC article.Review.
- Coagulation System Activation for Targeting of COVID-19: Insights into Anticoagulants, Vaccine-Loaded Nanoparticles, and Hypercoagulability in COVID-19 Vaccines.Abdel-Bakky MS, Amin E, Ewees MG, Mahmoud NI, Mohammed HA, Altowayan WM, Abdellatif AAH.Abdel-Bakky MS, et al.Viruses. 2022 Jan 24;14(2):228. doi: 10.3390/v14020228.Viruses. 2022.PMID:35215822Free PMC article.Review.
- Early recognition and treatment of pre-VITT syndrome after adenoviral vector-based SARS-CoV-2 vaccination may prevent from thrombotic complications: review of published cases and clinical pathway.Salih F, Kohler S, Schönborn L, Thiele T, Greinacher A, Endres M.Salih F, et al.Eur Heart J Open. 2022 May 16;2(3):oeac036. doi: 10.1093/ehjopen/oeac036. eCollection 2022 May.Eur Heart J Open. 2022.PMID:35919343Free PMC article.Review.
- Postpartum Spinal Cord Infarction: A Case Report and Review of the Literature.Hsu JL, Chin SC, Cheng MH, Wu YR, Ro A, Ro LS.Hsu JL, et al.Medicines (Basel). 2022 Oct 31;9(11):54. doi: 10.3390/medicines9110054.Medicines (Basel). 2022.PMID:36355059Free PMC article.
References
- Wiersinga W.J., Rhodes A., Cheng A.C., Peacock S.J., Prescott H.C. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;324(08):782–793. - PubMed
- WHO Coronavirus (COVID-19) Dashboard. World Health Organization; Geneva: 2021.https://covid19.who.int/ Available at. Accessed April 21, 2021.
Publication types
MeSH terms
Substances
Related information
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous