Case Reports
Vol. 1 No. 2 (2022)
Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases
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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
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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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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. 21];1(2). Available from: https://www.btvb.org/btvb/article/view/23
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