Case Reports
Vol. 1 No. 2 (2022)
Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 1 March 2022
Accepted: 6 May 2022
Accepted: 6 May 2022
4032
Views
0
Downloads
Authors
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.
Downloads
Download data is not yet available.
Citations
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]
How to Cite
1.
Santoro RC, Minici R, Leotta M, Falbo M, Elia LC, Leo F, et al. Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases. Bleeding Thromb Vascul Biol [Internet]. 2022 May 23 [cited 2026 Jan. 23];1(2). Available from: https://www.btvb.org/btvb/article/view/23
Copyright (c) 2022 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Similar Articles
- PO70 | Clinical safety and monitoring of apixaban combined with tacrolimus and everolimus in kidney transplant patients: a prospective study , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO42 | Acquired Von Willebrad syndrome in patients with myeloproliferative syndrome: literature review and single-center experience , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- PO03 | Enlarged platelets with reduced GP IB/IX can indicate disorders other than Bernard-Soulier syndrome , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Giovanni de Gaetano, The importance of rigorous and engaging scientific communication , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 2 (2025)
- Giovanni Di Minno, Gaia Spadarella, Ilenia Lorenza Calcaterra, Giancarlo Castaman, Paolo Simioni, Raimondo De Cristofaro, Cristina Santoro, Flora Peyvandi, Matteo Di Minno, The evolving landscape of gene therapy for congenital severe hemophilia: a 2024 state of the art , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 2 (2024)
- Pier Mannuccio Mannucci, Gene transfer in hemophilia A: not cogent yet , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 1 (2022)
- PO96 | Patient management with arteriovenous thrombotic manifestation and hemorrhagic complications , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. s1 (2025)
- Paolo Prandoni, Franca Bilora, Raffaele Pesavento, Giorgina Salgueiro, Angeles Blanco-Molina, Raquel Lòpez-Reyes, Manuel Monreal, and the RIETE Investigators, Treatment of venous thromboembolism in pregnancy: findings from the RIETE Registry , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Gary E. Raskob, Risk of recurrent venous thromboembolism in cancer patients after discontinuation of anticoagulant therapy , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. s1 (2024)
- Pier Mannuccio Mannucci, An ecological alliance against air pollution and cardiovascular disease , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 1 (2022)
You may also start an advanced similarity search for this article.
Most read articles by the same author(s)
- Silvia Linari, Renato Marino, Marzia Leotta, Antonio Coppola, Patrizia Di Gregorio, Augusto Bramante Federici, Flora Peyvandi, Cristina Santoro, Ezio Zanon, Rita Carlotta Santoro, The landscape of rare coagulation factor deficiency management in Italy: a national hemophilia center survey , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
- Renato Marino, Silvia Linari, Marzia Leotta, Antonio Coppola, Chiara Biasoli, Maria Elisa Mancuso, Flora Peyvandi, Cristina Santoro, Ezio Zanon, Rita Carlotta Santoro, Diagnostic and management practices for inherited fibrinogen disorders: a nationwide survey of Italian Hemophilia Treatment Centers , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 3 (2025)
