Case Reports
23 May 2022
Vol. 1 No. 2 (2022)
https://doi.org/10.4081/btvb.2022.23

Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases

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Thrombosis, Thrombocytopenia, Vaccine, SARS-CoV-2
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Rita Carlotta Santoro
ritacarlottasantoro@gmail.com
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Roberto Minici
Diagnostic Radiology Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Marzia Leotta
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Mariapia Falbo
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Lucia Concetta Elia
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Francesca Leo
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Antonella Ierardi
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Alessandra Strangio
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
Simona Prejanò
Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.

Vaccination with ChAdOx1 nCoV-19 can result in vaccine-induced immune thrombotic thrombocytopenia (VITT). This phenomenon mimics heparin-induced thrombocytopenia, yet it does not require heparin as a trigger. This case report highlights the potentially lifethreatening complication associated with ChAdOx1 nCov-19 vaccine, clinical presentation, diagnostic approach, and treatment. We report two cases of vaccine-induced immune thrombotic thrombocytopenia after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute these thrombotic conditions to the vaccine due to the remarkable temporal relationship. The proposed mechanism of VITT is a production of antibodies against platelet factor-4 resulting in massive platelet activation. Healthcare providers should be aware of the possibility of such a fatal complication, and the vaccine recipients should be warned about the symptoms of VITT.

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Crossref
Scopus
Google Scholar
Europe PMC
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet 2020;395:497–506. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Worldometers. Coronavirus (COVID-19) Mortality Rate. Available from: https://www.worldometers.info/coronavirus/coronavirus-death-rate/ [Accessed 14 September 2021].
Forni G, Mantovani A, Forni G, et al. COVID-19 vaccines: where we stand and challenges ahead. Cell Death Differ 2021;28:626-39. DOI: https://doi.org/10.1038/s41418-020-00720-9
Scully M, Singh D, Lown R, et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination. N Engl J Med 2021;384:2202-11. DOI: https://doi.org/10.1056/NEJMoa2105385
Schultz NH, Sørvoll IH, Michelsen AE, et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination. N Engl J Med 2021;384:2124–30. DOI: https://doi.org/10.1056/NEJMoa2104882
Greinacher A, Thiele T, Warkentin TE, et al. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384:2092–101. DOI: https://doi.org/10.1056/NEJMoa2104840
See I, Su JR, Lale A, et al. US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021. JAMA 2021;325:2448-56. DOI: https://doi.org/10.1001/jama.2021.7517
Kenda J, Lovric D, Skerget M, Milivojevic N. Treatment of ChAdOx1 nCoV-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia Related Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2021;30:106072. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106072
Al-Mayhani T, Saber S, Stubbs MJ, et al. Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia. J Neurol Neurosurg Psychiatry 2021;92:1247-8. DOI: https://doi.org/10.1136/jnnp-2021-326984
De Michele M, Iacobucci M, Chistolini A, et al. Malignant cerebral infarction after ChAdOx1 nCoV-19 vaccination: a catastrophic variant of vaccine-induced immune thrombotic thrombocytopenia. Nat Commun 2021;12:4663. DOI: https://doi.org/10.1038/s41467-021-25010-x
Blauenfeldt RA, Kristensen SR, Ernstsen SL, et al. Thrombocytopenia with acute ischemic stroke and bleeding in a patient newly vaccinated with an adenoviral vector-based COVID-19 vaccine. J Thromb Haemost 2021;19:1771-5. DOI: https://doi.org/10.1111/jth.15347
Walter U, Fuchs M, Grossmann A, et al. Adenovirus-vectored COVID-19 vaccine-induced immune thrombosis of carotid artery: a case report. Neurology 2021;10:1212. DOI: https://doi.org/10.1212/WNL.0000000000012576
Arepally GM, Ortel TL. Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT): What We Know and Don't Know. Blood 2021;138:293-8. DOI: https://doi.org/10.1182/blood.2021012152
Ponero C, Sessa F, Ciaccio M et al. Post-mortem findings in vaccine-induced thrombotic thrombocytopenia. Haematologica 2021;106:2291-3. https://doi.org/10.3324/haematol.2021.279075 DOI: https://doi.org/10.3324/haematol.2021.279075
Gresele P, Marietta M, Ageno W, et al. Management of cerebral and splanchnic vein thrombosis associated with thrombocytopenia in subjects previously vaccinated with Vaxrevria: a position statement from the Italian Society for the Study of Haemostasis and Thrombosis (SISET). Blood Transfus 2021;19:281-3. https://doi.org/10.2450/2021.0131-21
SISET. Database nazionale sui casi di trombosi dopo vaccinazione contro Sars-CoV-2: SISET VAX COVID-19. Available from: https://www.siset.org/sisetvaxcovid-19/ [Accessed 2 September 2021]
Marzia Leotta, Hemostasis and Thrombosis Center Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro

 

 

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Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases. (2022). Bleeding, Thrombosis and Vascular Biology, 1(2). https://doi.org/10.4081/btvb.2022.23
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