Case Reports
Vol. 2 No. 2 (2023)
Long-term persistence of high anti-PF4 antibodies titer in a challenging case of AZD1222 vaccine-induced thrombotic thrombocytopenia
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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: 19 March 2023
Accepted: 1 June 2023
Accepted: 1 June 2023
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A syndrome occurring after adenoviral vector anti-SARS-CoV-2 vaccination, characterized by thrombocytopenia, venous thrombosis, and circulating anti-PF4 antibodies, known as vaccine-induced immune thrombotic thrombocytopenia (VITT), is well described. Data on the long-term course of this syndrome are lacking. Our aim is to report the clinical and laboratory features of a patient with VITT from diagnosis and during 21 months of follow-up. Cerebral venous thrombosis associated with elevated D-dimer, low fibrinogen, thrombocytopenia, and anti-PF4 antibodies positivity occurred in this patient after ChAdOx1 nCoV-19 vaccination. Cerebral thrombosis required a revascularization procedure and decompressive craniectomy. Upon dexamethasone and anticoagulant treatment initiation, the platelet count recovered. However, a persistently high anti-PF4 antibody titer, without thrombosis recurrence, was observed. Little is known about the long-term persistence of anti-PF4 antibodies, their clinical significance, and their possible role in guiding therapeutic decisions. In our patient, we decided to continue anticoagulant treatment beyond 21 months with parallel anti-PF4 antibody monitoring.
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Citations
Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021;384(22):2092-2101. DOI: https://doi.org/10.1056/NEJMoa2104840
Schultz NH, Sorvoll IH, Michelsen AE, et al. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;384(22):2124-2130. DOI: https://doi.org/10.1056/NEJMoa2104882
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(23):2202-2211. DOI: https://doi.org/10.1056/NEJMoa2105385
Nazy I, Sachs UJ, Arnold DM, et al. Recommendations for the clinical and laboratory diagnosis of VITT against COVID-19: Communication from the ISTH SSC Subcommittee on Platelet Immunology. J Thromb Haemost. 2021;19(6):1585-1588. DOI: https://doi.org/10.1111/jth.15341
Arepally GM, Ortel TL. Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know. Blood. 2021;138(4):293-298. DOI: https://doi.org/10.1182/blood.2021012152
Oldenburg J, Klamroth R, Langer F, et al. Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH. Hamostaseologie. 2021;41(3):184-189. DOI: https://doi.org/10.1055/a-1469-7481
Gresele P, Marietta M, Ageno W, et al. Management of cerebral and splanchnic vein thrombosis associated with thrombocytopenia in subjects previously vaccinated with Vaxzevria (AstraZeneca): a position statement from the Italian Society for the Study of Haemostasis and Thrombosis (SISET). Blood Transfus. 2021;19(4):281-283.
Lindhoff-Last E, Schoenborn L, Piorkowski M, et al. Heterogeneity of Vaccine-Induced Immune Thrombotic Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination and Safety of Second Vaccination with BNT162b2. Thromb Haemost. 2022;122(2):304-307. DOI: https://doi.org/10.1055/a-1701-2926
. COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT). London; 2022.
Thaler J, Jilma P, Samadi N, et al. Long-term follow-up after successful treatment of vaccine-induced prothrombotic immune thrombocytopenia. Thromb Res. 2021;207:126-130. DOI: https://doi.org/10.1016/j.thromres.2021.09.017
Gunther A, Bramer D, Pletz MW, et al. Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia-A Case Report. Vaccines (Basel). 2021;9(11). DOI: https://doi.org/10.3390/vaccines9111344
Schonborn L, Thiele T, Kaderali L, Greinacher A. Decline in Pathogenic Antibodies over Time in VITT. N Engl J Med. 2021;385(19):1815-1816. DOI: https://doi.org/10.1056/NEJMc2112760
Craven B, Lester W, Boyce S, et al. Natural history of PF4 antibodies in vaccine-induced immune thrombocytopenia and thrombosis. Blood. 2022;139(16):2553-2560. DOI: https://doi.org/10.1182/blood.2021014684
Schonborn L, Thiele T, Kaderali L, et al. Most anti-PF4 antibodies in vaccine-induced immune thrombotic thrombocytopenia are transient. Blood. 2022;139(12):1903-1907. DOI: https://doi.org/10.1182/blood.2021014214
Cari L, Alhosseini MN, Fiore P, et al. Cardiovascular, neurological, and pulmonary events following vaccination with the BNT162b2, ChAdOx1 nCoV-19, and Ad26.COV2.S vaccines: An analysis of European data. J Autoimmun. 2021;125:102742. DOI: https://doi.org/10.1016/j.jaut.2021.102742
Pavord S, Scully M, Hunt BJ, et al. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. N Engl J Med. 2021;385(18):1680-1689. DOI: https://doi.org/10.1056/NEJMoa2109908
Lundstrom K, Barh D, Uhal BD, et al. COVID-19 Vaccines and Thrombosis-Roadblock or Dead-End Street? Biomolecules. 2021;11(7). DOI: https://doi.org/10.3390/biom11071020
How to Cite
1.
Barcella L, Ambaglio C, Gritti P, Schieppati F, Brusegan V, Sanga E, et al. Long-term persistence of high anti-PF4 antibodies titer in a challenging case of AZD1222 vaccine-induced thrombotic thrombocytopenia. Bleeding Thromb Vascul Biol [Internet]. 2023 Jun. 28 [cited 2026 Jan. 21];2(2). Available from: https://www.btvb.org/btvb/article/view/72
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