Immune thrombocytopenia associated with COVID-19 mRNA vaccine tozinameran – a clinical case and global pharmacovigilance data

Battegay, R; Istampoulouoglou, Ioanna; Holbro, Andreas; Buser, Andreas; Hirsiger, Julia R; Eckstein, Jens; Berger, Christoph; Koechlin, Sarah; Leuppi-Taegtmeyer, Anne

doi:10.4414/smw.2021.w30084

Cited by 9 publications

(4 citation statements)

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“…However, a small number of case reports described similar adverse effects after mRNA vaccines. While it has been postulated that post-vaccine ICH occurs mainly due to hemorrhagic transformation of cerebral venous thrombosis caused by autoimmune thrombocytopenia (resembling heparin-induced thrombocytopenia), the exact mechanism is still not fully understood and requires further elucidation [ 90 , 91 , 92 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since VITT and CVST are both reported as very rare adverse reactions to COVID-19 viral vector vaccines, most reports relate to the ChAdOx1 nCoV-19 vaccine (AstraZeneca). However, there were also reports describing similar symptoms after Janssen (Ad26.COV2.S) [ 89 ] as well as Comirnaty mRNA (Pfizer-BioNtech) and mRNA-1273 (Moderna) vaccines [ 90 , 91 , 92 ].…”

Section: Hemorrhagic Strokementioning

confidence: 99%

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Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia

Sojka

Drelich-Zbroja

Kuczyńska

et al. 2022

IJERPH

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Since the very beginning of the COVID-19 pandemic, numerous researchers have made an effort to determine the molecular composition of the SARS-CoV-2 virus, and the exact pathomechanism through which the virus exerts such a devastating effect on the host/infected organism. Recent scientific evidence highlights the affinity of the virus towards ACE2 receptors, which are widespread in multiple human systems, including the central nervous system (CNS) and cerebral vessels. Such an affinity may explain endothelial dysfunction and damage that is observed in COVID-positive patients in histopathological studies, with subsequent dysregulation of the cerebral circulation leading to transient or acute cerebrovascular accidents. In this paper, we aimed to evaluate the effects of COVID-related hypoxemia and direct viral invasion on the cerebral circulation, with special respect to the postulated pathomechanism, vulnerable groups of patients, clinical course and outcomes, as well as diagnostic imaging findings.

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Section: Discussionmentioning

confidence: 99%

Section: Hemorrhagic Strokementioning

confidence: 99%

Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia

Sojka

Drelich-Zbroja

Kuczyńska

et al. 2022

IJERPH

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“…Reports have also recommended measuring platelet counts on days 3–7 after vaccination to confirm the presence or absence of ITP flare-up [ 167 ]. Some reports have described ITP cases after vaccination in which the patients were able to receive additional vaccinations without problems [ 168 ].…”

Section: Sars-cov-2 Vaccination-associated Coagulopathymentioning

confidence: 99%

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

Yamada

Asakura

2022

IJMS

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Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.

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“…This study aimed to evaluate the risk of ischaemic stroke or systemic embolism following BNT162b2 and CoronaVac vaccination in patients with AF. As these patients are recommended to use oral anticoagulants, which are associated with the risk of bleeding, 3 and as bleeding was reported as a potential side effect of COVID-19 vaccines, 10 , 20 the risk of bleeding following vaccination was also investigated in this study.…”

Section: Introductionmentioning

confidence: 99%

Sex-based differences in risk of ischaemic stroke or systemic embolism after BNT162b2 or CoronaVac COVID-19 vaccination in patients with atrial fibrillation: a self-controlled case series and nested case-control study

Huang

Yan

et al. 2023

European Heart Journal - Cardiovascular Pharmacotherapy

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Aims Patients with atrial fibrillation (AF) have a higher risk of ischemic stroke or systemic embolism with a greater risk for female patients. This study aims to evaluate the risk of ischemic stroke or systemic embolism and bleeding following COVID-19 vaccination in patients with AF and the sex differences. Methods and results Self-controlled case series (SCCS) analysis was conducted to evaluate the risk of ischemic stroke or systemic embolism and bleeding following BNT162b2 or CoronaVac in patients with AF, using the territory-wide electronic medical records from the Hospital Authority and vaccination records from the Department of Health in Hong Kong. Patients with a primary diagnosis of ischemic stroke or systemic embolism or bleeding in the inpatient setting between February 23, 2021 and March 31, 2022 were included. A nested case-control analysis was also conducted with each case randomly matched with ten controls according to sex, age, Charlson comorbidity index and date of hospital admission. Conditional Poisson regression was used in the SCCS analysis and conditional logistic regression was used in nested case-control analysis to assess the risks and all analyses were stratified by sex and type of vaccines. Among 51 158 patients with AF, we identified an increased risk of ischemic stroke or systemic embolism after the first dose of BNT162b2 in SCCS analysis during 0–13 days (incidence rate ratio 6.60[95% CI 1.51–28.77]) and 14–27 days (6.53[95% CI 1.31–32.51]), and nested case-control analysis during 0–13 days (adjusted odds ratio 6.21 [95% CI 1.14–33.91]) and 14–27 days (5.52 [95% CI 1.12–27.26]) only in female patients. The increased risk in female patients following the first dose of CoronaVac was only detected during 0–13 days (3.88 [95% CI 1.67–9.03]) in the nested case-control analysis. No increased risk of ischemic stroke or systemic embolism was identified in male patients and no increased risk of bleeding was detected in all patients with AF for both vaccines. An increased risk of ischemic stroke or systemic embolism after COVID-19 was also observed in both females (17.42 [95% CI 5.08–59.73]) and males (6.63 [95% CI 2.02–21.79]). Conclusions The risk of ischemic stroke or systemic embolism after COVID-19 vaccination was only increased in female patients with AF. However, as the risk after COVID-19 was even higher, proactive uptake of COVID-19 vaccines is recommended to prevent the potential severe outcomes after infection.

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Immune thrombocytopenia associated with COVID-19 mRNA vaccine tozinameran – a clinical case and global pharmacovigilance data

Cited by 9 publications

References 0 publications

Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia

Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

Sex-based differences in risk of ischaemic stroke or systemic embolism after BNT162b2 or CoronaVac COVID-19 vaccination in patients with atrial fibrillation: a self-controlled case series and nested case-control study

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