Acquired thrombotic thrombocytopenic purpura: A rare disease associated with BNT162b2 vaccine: Comment from Doyle et al.

Doyle, Andrew J.; Springell, Deborah; Dutt, Tina; Kenworthy, Jessica; Ling, Gavin; Desborough, Michael; Thomas, Will; Hermans, Joannes; Vanveen, Joost; Cranfield, Tanya; Belsham, Edward; Hill, Quentin A.; Lester, Will; Scully, Marie

doi:10.1111/jth.15632

Cited by 4 publications

(7 citation statements)

References 8 publications

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“…They proposed an ADATMS13 cutoff of 20% above which patients could be safely vaccinated. We also found a comment in literature from Doyle et al, who sought to correlate the TTP (de novo or relapse) occurrences with the vaccination program rollout in England [35] . They reported that there was no increase in the number of TTP presentations during peak vaccination times in a nationwide cohort, and that incidence of de novo cases was well within an expected range for their population [35] .…”

Section: Discussionmentioning

confidence: 79%

“…We also found a comment in literature from Doyle et al, who sought to correlate the TTP (de novo or relapse) occurrences with the vaccination program rollout in England [35] . They reported that there was no increase in the number of TTP presentations during peak vaccination times in a nationwide cohort, and that incidence of de novo cases was well within an expected range for their population [35] . On similar lines, in a small cohort of 12 patients with a known history of immune TTP, Schiepatti et al observed no change in ADAMTS13 activity or inhibitor level on days 21 and 60 after the patients received their COVID-19 vaccine [36] .…”

Section: Discussionmentioning

confidence: 79%

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Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

Saluja

Gautam

Yadala

et al. 2022

Thrombosis Research

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 79%

Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

Saluja

Gautam

Yadala

et al. 2022

Thrombosis Research

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“…Consistently, in these studies the number of presentations of iTTP during the peak of the vaccination program was not different than the expected incidence of iTTP in each respective country. [18][19][20] It has been hypothesized that vaccination could precipitate acute iTTP in patients with low ADAMTS-13 activity. 19,20 However, in a recently published paper showing 4 of 32 iTTP patients clinically relapsing within 30 days from the second BNT162b2 vaccine dose, only one had an ADAMTS-13 <20% before vaccination.…”

Section: Discussionmentioning

confidence: 99%

Hemostatic Profile and Serological Response of Patients with Immune Thrombotic Thrombocytopenic Purpura after Receiving BNT162b2 Vaccine: A Prospective Study

et al. 2023

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Introduction Coronavirus disease is a clinical challenge for patients with autoimmune conditions. Patients affected by immune thrombotic thrombocytopenic purpura (iTTP) are particularly vulnerable to SARS-CoV-2 infection. Protecting these patients with vaccination is therefore mandatory, although concerns may exist on a possible increased thrombotic risk or risk of disease relapse after vaccine exposure. So far, there is no information on serological response and hemostatic activation in iTTP patients after SARS-CoV-2 vaccination. Materials and Methods In this study, in April 2021, we enrolled iTTP patients in clinical remission and on regular outpatient follow-up to receive the first and second dose BNT162b2 vaccine as a part of a prospective trial aimed at monitoring for 6 months after vaccination the occurrence of subclinical laboratory signs of clotting activation, as well as overt thrombotic complications or disease relapse. The seroconversion response was monitored in parallel. The results were compared with those of control non-iTTP subjects. Results A moderate decrease of ADAMTS-13 activity was recorded at 3 and 6 months in five patients with normal values at baseline, while an ADAMTS-13 relapse occurred at 6 months in one patient. Abnormalities in the endothelium activation biomarkers postvaccination were observed in iTTP patients compared with controls. The immunological response to vaccine was overall positive. No clinical iTTP relapses or thrombotic events manifested in the 6 month-follow-up after vaccination. Conclusion The results of this study are in favor of efficacy and safety of mRNA vaccines in patients with iTTP, and highlight the importance of long-term monitoring of iTTP patients.

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“…A recent case series suggested an association with acquired TTP and the BNT162b2 vaccine, 8 which was subsequently contradicted by the UKTTP registry after they did not find an increased incidence in their nationwide cohort. 12 There is, therefore, a clear need for detailed reporting of potential implicated drugs. Many reports we reviewed omitted basic information, including concurrent medication.…”

Section: Discussionmentioning

confidence: 99%

“…However, case series and reports report on rare diseases based often on common exposures and therefore are prone to observation and reporting biases. A recent case series suggested an association with acquired TTP and the BNT162b2 vaccine, 8 which was subsequently contradicted by the UKTTP registry after they did not find an increased incidence in their nationwide cohort 12 . There is, therefore, a clear need for detailed reporting of potential implicated drugs.…”

Section: Discussionmentioning

confidence: 99%

Drug‐induced thrombotic thrombocytopenic purpura: A systematic review and review of European and North American pharmacovigilance data

et al. 2022

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Summary Many medications have been reported to be associated with thrombotic thrombocytopenic purpura (TTP) through pharmacovigilance data and published case reports. Whilst there are existing data available regarding drug‐induced thrombotic microangiopathy, there is no available synthesis of evidence to assess drug‐induced TTP (DI‐TTP). Despite this lack of evidence, patients with TTP are often advised against using many medications due to the theoretical risk of DI‐TTP. This systematic review evaluated the evidence for an association of medications reported as potential triggers for TTP. Of 5098 records available 261 articles were assessed further for eligibility. Fifty‐seven reports, totalling 90 patients, were included in the final analysis. There were no cases where the level of association was rated as definite or probable, demonstrating a lack of evidence of any drug causing DI‐TTP. This paucity of evidence was also demonstrated in the pharmacovigilance data, where 613 drugs were reported as potential causes of TTP without assessment of the strength of association. This systematic review demonstrates the need for standardised reporting of potential drugs causing TTP. Many reports omit basic information and, therefore, hinder the chance of finding a causative link if one exists.

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Acquired thrombotic thrombocytopenic purpura: A rare disease associated with BNT162b2 vaccine: Comment from Doyle et al.

Cited by 4 publications

References 8 publications

Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

Thrombotic thrombocytopenic purpura (TTP) after COVID-19 vaccination: A systematic review of reported cases

Hemostatic Profile and Serological Response of Patients with Immune Thrombotic Thrombocytopenic Purpura after Receiving BNT162b2 Vaccine: A Prospective Study

Drug‐induced thrombotic thrombocytopenic purpura: A systematic review and review of European and North American pharmacovigilance data

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