ChAdOx1 nCoV-19 Vaccine and Thrombosis with Thrombocytopenia Syndrome among Adults: A Systematic Review

Abstract

Several vaccine-induced thrombotic thrombocytopenia syndrome (VITTS) cases have been reported after the ChAdOx1 nCov-19 vaccination. The current study systematically reviewed the reported post-ChAdOx1 nCoV-19 vaccination thrombotic thrombocytopenia cases. Their laboratory and clinical features, as well as the diagnostic and therapeutic measures, were investigated. Online databases were searched until 25 August 2021. Studies reporting post-ChAdOx1 nCov-19 vaccination TTS were included. Overall, 167 cases (21-77 years old) from 53 publications were included showing a female dominance of 1.75 times. About 85% of the cases exhibited the primary symptoms within the first two weeks post-vaccination. Headache was the most common initial symptom (>44.2%), and hemorrhage/thrombotic problems (22.46%), as well as discoordination/weakness/numbness/hemiparesis/cyanotic toes (19.6%), were the most prevalent uncommon initial symptoms. Prothrombin time (PT), D-dimers, and C-reactive protein were the most remarkable increased laboratory parameters in 50.6%, 99.1%, and 55.6% of cases, respectively. In comparison, platelet and fibrinogen were the most remarkable decreased laboratory parameters in 92.7% and 50.5% of cases, respectively. Most VITT cases presented with cerebral venous thrombosis (CVT)/cerebral venous sinus thrombosis (CVST), supraventricular tachycardia (SVT), transverse sinus/cerebral thrombosis, pulmonary embolism (PE), and cerebral hemorrhage. Anti-PF4 antibody measurement through immunoassays and functional assays were positive in 86.2% and 73% of cases, respectively. About 31% of the cases died. Early diagnosis and proper therapeutic measures are important in ChAdOx1 nCov-19 vaccine-induced VITTS patients. Therefore, experts are recommended to know the corresponding clinical and laboratory features, as well as diagnostic methods. Elucidation of the pathophysiologic mechanism of ChAdOx1 nCov-19 vaccine-induced TTS deserves further investigation.

A Dança Descontrolada do Coração: Uma Revisão Sistemática sobre Taquiarritmias - Estratégias de Diagnóstico, Abordagens Terapêuticas e Desafios Emergentes

“…A compreensão desses elementos é crucial não apenas para a identificação precoce e o gerenciamento eficaz da arritmia, mas também para a implementação de estratégias preventivas direcionadas a indivíduos em risco. À medida que a pesquisa avança, a investigação aprofundada desses fatores de risco proporcionará insights valiosos para a abordagem clínica e a prevenção da fibrilação atrial em diversas populações 6,7 .…”

“…A abordagem diagnóstica da fibrilação atrial é fundamentada em sinais eletrocardiográficos distintos que refletem a natureza caótica e descoordenada da atividade elétrica atrial. Dois marcadores-chave na identificação dessa arritmia são a ausência de onda P discernível e a irregularidade dos intervalos RR no eletrocardiograma 6,7 .…”

“…Na fibrilação atrial, entretanto, a atividade elétrica atrial torna-se desorganizada e não há uma onda P discernível. Em vez disso, o traçado do ECG exibe uma série de ondas pequenas e irregulares, conhecidas como ondas fibrilatórias 6,7 .…”

“…Um desafio notável reside na individualização do tratamento, considerando as características específicas de cada paciente, como idade, comorbidades e tolerância aos medicamentos. A gestão de pacientes idosos, em particular, requer uma abordagem adaptada às necessidades e peculiaridades dessa população 7,8 .…”

Factors Related to Caregivers’ Intention to Vaccinate Their Elderly Family Members with Major Neurocognitive Disorders against COVID-19

“…Major adverse effects of COVID-19 vaccines, such as cardiovascular, neurologic, hematologic, and immune-allergic side effects, have also been reported [ 22 ]. For example, several vaccine-induced thrombotic thrombocytopenia syndrome cases have been reported after the ChAdOx1 nCov-19 vaccination [ 23 ]. Research also found that elderly individuals with MNDs who were younger, had higher cognitive and daily functions, and had no neuropsychiatric symptoms of agitation and aggression were more likely to receive the COVID-19 vaccination, whereas caregivers who had a lower overall caregiver burden and burden of frustration were more likely to vaccinate their elderly family members with MNDs [ 20 ].…”