Introduction This systematic review aimed to retrieve patients diagnosed with de novo immune thrombocytopenic purpura (ITP) after COVID‐19 immunization to determine their epidemiological characteristics, clinical course, therapeutic strategies, and outcome. Materials and Methods We conducted the review using four major databases, comprising PubMed, Scopus, Web of Science, and the Cochrane library, until April 2022. A systematic search was performed in duplicate to access eligible articles in English. Furthermore, a manual search was applied to the chosen papers' references to enhance the search sensitivity. Data were extracted and analyzed with the SPSS 20.1 software. Results A total of 77 patients with de novo COVID‐19 vaccine‐associated ITP were identified from 41 studies, including 31 case reports and 10 case series. The median age of patients who developed COVID‐19 vaccine‐associated ITP was 54 years (IQR 36–72 years). The mRNA‐based COVID‐19 vaccines, including BNT16B2b2 and mRNA‐1273, were most implicated (75.4%). Those were followed by the adenovirus vector‐based vaccines, inclusive of ChAdOx1 nCoV‐19 and vAd26.COV2.S. No report was found relating ITP to other COVID‐19 vaccines. Most cases (79.2%) developed ITP after the first dose of COVID‐19 vaccination. 75% of the patients developed ITP within 12 days of vaccination, indicating a shorter lag time compared to ITP after routine childhood vaccinations. Sixty‐seven patients (87%) patients were hospitalized. The management pattern was similar to primary ITP, and systemic glucocorticoids, IVIg, or both were the basis of the treatment in most patients. Most patients achieved therapeutic goals; only two individuals required a secondary admission, and one patient who presented with intracranial hemorrhage died of the complication. Conclusions De novo ITP is a rare complication of COVID‐19 vaccination, and corresponding reports belong to mRNA‐based and adenovirus vector‐based vaccines, in order of frequency. This frequency pattern may be related to the scale of administration of individual vaccines and their potency in inducing autoimmunity. The more the COVID‐19 vaccine is potent to induce antigenic challenge, the shorter the lag time would be. Most patients had a benign course and responded to typical treatments of primary ITP.

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Objective Evaluating the degree of extracranial stenosis is important in predicting the risk of cerebrovascular events and to assess if the patient can benefit from any intervention. Non-invasive methods, like Doppler Ultrasonography (DUS) are preferred to invasive methods such as Digital Subtraction Angiography (DSA). Methods In this retrospective study, the level of agreement between DUS and DSA regarding the degree of stenosis of Internal Carotid Arteries (ICAs) and Vertebral Arteries (VAs) was assessed. The degree of ICA stenosis was classified into 5 groups. DSA was assumed as the gold standard. VA stenosis was classified into two groups of more or less than 50% stenosis. Results A total of 428 ICAs were assessed. Based on DSA results, DUS could estimate the degree of arterial stenosis in groups of 0–15% stenosis and 100% stenosis most accurately, and the least accuracy was in groups of 50–69% and 70–99% stenosis. The overall agreement between DUS and DSA in the classified ICA stenosis was moderate (Weighted Kappa = 0.565, P < 0.001). Also, the agreement of DUS and DSA when classifying ICA stenosis into two groups of above and below 50%, was moderate (Kappa = 0.583, P < 0.001). DUS was most sensitive and specific in the group of 100% stenosis (Sensitivity: 0.75 Specificity: 0.99) as well as the group of 1–15% stenosis (Sensitivity: 0.80 Specificity: 0.76). Also, DUS was least sensitive in group of 50–69% stenosis (Sensitivity: 0.11 Specificity: 0.94). Regarding VAS, 108 arteries were assessed and the agreement between DUS and DSA was fair (Kappa = 0.248, CI95 = −0.013 - 0.509, P < 0.01). Conclusions DUS can be used as the first-line screening tool for detecting extra cranial arteries stenosis. The practicality of the DUS as a screening tool for extracranial VAs stenosis appears to be limited.

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