Journal article
Authors list: Panagiota, Victoria; Dobbelstein, Christiane; Werwitzke, Sonja; Ganser, Arnold; Cooper, Nina; Sachs, Ulrich J.; Tiede, Andreas
Publication year: 2022
Journal: Viruses
Volume number: 14
Issue number: 8
eISSN: 1999-4915
Open access status: Gold
DOI Link: https://doi.org/10.3390/v14081702
Publisher: MDPI
Abstract:
Vaccine-induced thrombotic thrombocytopenia (VITT), or thrombosis with thrombocytopenia syndrome (TTS), is a rare but serious complication of adenovirus-based vaccines against severe respiratory syndrome coronavirus 2 (SARS-CoV-2). Observation of long-term outcomes is important to guide treatment of affected patients. This single-center consecutive cohort study included all patients diagnosed based on (1) vaccination 4 to 21 days before symptom onset, (2) signs or symptoms of venous or arterial thrombosis, (3) thrombocytopenia < 150/nL, (4) positive anti-platelet factor 4 (PF4) antibody, and (5) elevated D-Dimer > 4 times the upper limit of normal. Nine patients were enrolled. Acute management consisted of parenteral anticoagulants, corticosteroids, intravenous immunoglobulin (IVIG), and/or eculizumab. Eculizumab was successfully used in two patients with recurrent thromboembolic events after IVIG. Direct oral anticoagulants were given after hospital discharge. Median follow-up duration was 300 days (range 153 to 380). All patients survived the acute phase of the disease and were discharged from hospital. One patient died from long-term neurological sequelae of cerebral venous sinus thrombosis 335 days after diagnosis. Eight out of nine patients were alive at last follow-up, and seven had fully recovered. Anti-PF4 antibodies remained detectable for at least 12 weeks after diagnosis, and D-Dimer remained elevated in some patients despite oral anticoagulation. No recurrent thromboembolic events, other signs of VITT relapse, or bleeding complications occurred after discharge. In conclusion, VITT appears to be a highly prothrombotic condition. IVIG is not always successful, and eculizumab may be considered a rescue agent. Long-term management with direct oral anticoagulants appears to be safe and effective.
Citation Styles
Harvard Citation style: Panagiota, V., Dobbelstein, C., Werwitzke, S., Ganser, A., Cooper, N., Sachs, U., et al. (2022) Long-Term Outcomes after Vaccine-Induced Thrombotic Thrombocytopenia, Viruses, 14(8), Article 1702. https://doi.org/10.3390/v14081702
APA Citation style: Panagiota, V., Dobbelstein, C., Werwitzke, S., Ganser, A., Cooper, N., Sachs, U., & Tiede, A. (2022). Long-Term Outcomes after Vaccine-Induced Thrombotic Thrombocytopenia. Viruses. 14(8), Article 1702. https://doi.org/10.3390/v14081702
Keywords
AZD1222; cerebral venous sinus thrombosis; CHADOX1 NCOV-19; cohort studies; PLATELET ACTIVATION; SARS-COV-2; THROMBOSIS
