A quantitative risk-benefit analysis of ChAdOx1 nCoV-19 vaccine among people under 60 in Italy

Palladino, Raffaele; Ceriotti, Daniele; Ambrosi, Damiano De; Vito, Marta De; Farsoni, Marco; Seminara, Giuseppina; Barone-Adesi, Francesco

doi:10.1101/2021.05.07.21256826

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…74 Nevertheless, benefits of adenoviral vector vaccines, clearly demonstrated in randomized controlled trials, 75,76 still outweigh the risks of these rare thrombotic events, especially in subjects >30 years. 77 Interestingly, Hippisley-Cox et al 67 found an increased risk of ischemic stroke after 15 to 21 days from BNT162b2 mRNA vaccination (Pfizer BionTech), and after a positive SARS-CoV-2 test, but not after ChAdOx1 nCov-19 vaccination (Oxford-AstraZeneca). The same authors found an increased risk of thrombocytopenia after ChAdOx1 nCov-19 vaccination, and of CVST after ChAdOx1 nCoV-19 vaccination (at 8-14 days), after BNT162b2 mRNA vaccination (at 15-21 days), and after a positive SARS-CoV-2 test.…”

Section: Stroke As a Complication Of Covid-19 Vaccinationmentioning

confidence: 99%

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

Michele

Kahan

Berto

et al. 2022

Circulation Research

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The risk of stroke and cerebrovascular disease complicating infection with SARS-CoV-2 has been extensively reported since the onset of the pandemic. The striking efforts of many scientists in cooperation with regulators and governments worldwide have rapidly brought the development of a large landscape of vaccines against SARS-CoV-2. The novel DNA and mRNA vaccines have offered great flexibility in terms of antigen production and led to an unprecedented rapidity in effective and safe vaccine production. However, as mass vaccination has progressed, rare but catastrophic cases of thrombosis have occurred in association with thrombocytopenia and antibodies against PF4 (platelet factor 4). This catastrophic syndrome has been named vaccine-induced immune thrombotic thrombocytopenia. Rarely, ischemic stroke can be the symptom onset of vaccine-induced immune thrombotic thrombocytopenia or can complicate the course of the disease. In this review, we provide an overview of stroke and cerebrovascular disease as a complication of the SARS-CoV-2 infection and outline the main clinical and radiological characteristics of cerebrovascular complications of vaccinations, with a focus on vaccine-induced immune thrombotic thrombocytopenia. Based on the available data from the literature and from our experience, we propose a therapeutic protocol to manage this challenging condition. Finally, we highlight the overlapping pathophysiologic mechanisms of SARS-CoV-2 infection and vaccination leading to thrombosis.

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Section: Stroke As a Complication Of Covid-19 Vaccinationmentioning

confidence: 99%

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

Michele

Kahan

Berto

et al. 2022

Circulation Research

View full text Add to dashboard Cite

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COVID-19, Vaccines, and Thrombotic Events: A Narrative Review

Abrignani

Murrone

Luca

et al. 2022

JCM

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The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.

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Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features

et al. 2022

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Background and Objectives: Several authors have reported cervical and axillary lymphadenopathies as known side effects following anti-COVID-19 vaccine administration. Few data are available about atypical locations of post-anti-COVID-19 vaccine lymphadenopathy. In this investigation, we evaluated the incidence and prevalence of postvaccine lymphadenopathy ultrasound (US) features in atypical sites. Materials and Methods: In this retrospective study, we retrospectively selected 64 patients on whom US was performed between January and October 2021 due to COVID-19 vaccine-related lymphadenopathy. We investigated lymph node anatomical sites, presence, number, size, shape, cortical profile, hilum outline, superb microvascular imaging (SMI), and elastosonography. Results: A total of 170 nodes were assessed. Atypical location was demonstrated in 5/64 patients (7.8%). In all these cases, atypical nodal involvement was associated with lymphadenopathy in a typical site (axillary, supraclavicular) ipsilateral to the vaccine injection site. Two patients presented lymphadenopathy in the infraclavicular station (3.1%), one in the pectoralis major muscle (1.6%), one in the left arm (1.6%), and one in the nuchal site (1.6%). All lymphadenopathies were oval-shaped, with a median size of 0.9 ± 0.2 cm. US features included a symmetric cortex with hilum evidence (4/6, 60%), vascular signal at SMI in both the hilar region and periphery of lymph node (5/6, 83.3%), and a US elastography pattern resembling that of adjacent tissues (5/6, 83.3%). The median age of patients with lymphadenopathies in an atypical location was 23 years. The main type of vaccine associated with lymph node appearance in atypical sites was Moderna’s mRNA-1273 (60% of patients, 4/6 lymph nodes accounting for 66.7% among atypical locations). Conclusion: Post-COVID-19 vaccine administration lymphadenopathies in an atypical location represent an intense immune response to antigenic stimuli and they may show alarming US traits superimposed on malignant pathologies, which may complicate the patient’s clinical and diagnostic pathway. Despite no distinctive US features between reactive post-COVID-19 vaccination and malignant lymph nodes being available, careful examination of atypical lymph node locations associated with accurate knowledge of patients’ clinical background and delay of US exam to four to six weeks after vaccine injection should be considered.

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A quantitative risk-benefit analysis of ChAdOx1 nCoV-19 vaccine among people under 60 in Italy

Cited by 4 publications

References 7 publications

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

COVID-19, Vaccines, and Thrombotic Events: A Narrative Review

Atypical Sites of Lymphadenopathy after Anti-COVID-19 Vaccine: Ultrasound Features

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