Spontaneous HIT syndrome: Knee replacement, infection, and parallels with vaccine-induced immune thrombotic thrombocytopenia

Warkentin, Theodore E.; Greinacher, Andreas

doi:10.1016/j.thromres.2021.05.018

Cited by 81 publications

(81 citation statements)

References 112 publications

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“…While HIT requires heparin as a trigger, VITT does not. This has been described as being analogous to the syndrome of “spontaneous HIT.” 14 In VITT, the vaccine itself and/or its effect upon the host is assumed to be the trigger. It has been variously hypothesized that vaccine constituents form antigenic complexes with PF4, that EDTA in the vaccine induces microvascular permeability, and that vaccine components cause acute inflammatory reactions.…”

Section: Discussionmentioning

confidence: 99%

Vaccine‐induced immune thrombotic thrombocytopenia with ChAdOx1 nCoV‐19 is rare in Asia

Boonyawat

Angchaisuksiri

2022

Research and Practice in Thrombosis and Haemostasis

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Background Vaccination with ChAdOx1 n‐CoV‐19 is associated with a rare syndrome called vaccine‐induced immune thrombotic thrombocytopenia (VITT). VITT has been reported mainly in Western countries, whereas the report of VITT in Asians is sparse. Objectives To report a case series of VITT following ChAdOx1 n‐CoV‐19 in Thailand and to estimate the incidence of VITT among Asian countries. Methods We retrieved the number of VITT patients and the total inoculation doses from the database of the Thai Ministry of Public Health. We performed a literature search including published articles and gray literature to estimate the incidence of VITT. The incidences of VITT by countries and respective confidence intervals were calculated. Results By the end of August 2021, five VITT cases occurred after 15 million doses of ChAdOx1 n‐CoV‐19 in Thailand. The median age was 31 years, and 60% were women. The incidence of VITT is estimated at 1 in 3 million. In other Asian countries, only a few cases of VITT have been reported. The incidence of VITT is much lower than in those of Western countries, which is estimated at 1 in 100, 000. The fatality rate was 44% in this study. Conclusions Although the incidence of VITT in Asians is low, the mortality rate is substantially higher. We urge that public awareness of this syndrome be raised, as early recognition and appropriate treatment of this syndrome following ChAdOx1 n‐CoV‐19 are crucial to improve the outcome.

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Section: Discussionmentioning

confidence: 99%

Vaccine‐induced immune thrombotic thrombocytopenia with ChAdOx1 nCoV‐19 is rare in Asia

Boonyawat

Angchaisuksiri

2022

Research and Practice in Thrombosis and Haemostasis

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“…Some authors prefer the term thrombosis with thrombocytopenia syndrome in the absence of laboratory-proven immunological mechanisms. Similarly, pre-VITT syndrome has been reserved for patients who present with clinical and laboratory ndings of VITT without imaging of thrombosis following vaccination 23,24 . A remarkable feature of thrombosis in VITT is that, in addition to occurring in typical sites of venous thrombosis (lungs and lower limbs), it shows a predilection for unusual locations, such as cerebral and ophthalmic veins 22,25 .…”

Section: Discussionmentioning

confidence: 99%

Brain Dural Arteriovenous Fistulas in the Covid-19 era: a warning and rationale for association

García-García

Cepeda

Arrese

et al. 2022

Preprint

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Background Brain dural arteriovenous fistulas(bDAVFs) are anomalous connections between dural arteries and cerebral veins or sinuses. Cerebral venous thrombosis(CVT) often precedes or coincides with bDAVFs and is considered a risk factor for these vascular malformations. Recently, vaccine-induced thrombotic thrombocytopenia causing CVTs has been associated with COVID-19 vaccines. Concurrently with the start of massive vaccination in our region, we have observed a fivefold increase in the average incidence of bDAVFs. Objective To raise awareness of the potential involvement of COVID-19 vaccines in the pathogenesis of bDAVF. Methods A retrospective review of demographic, clinical, radiological, COVID-19 infection and vaccination data of patients diagnosed with bDAVFs between 2011-2021 was conducted. Patients were divided into two cohorts according to their belonging to pre- or post-COVID-19 vaccination times. Cohorts were compared for bDAVFs incidences and demographic and clinical features. Results Twenty-one bDAVFs were diagnosed between 2011- 2021, 7 of which were diagnosed in 2021. The mean age was 57.7 years, and 62% were males. All cases except one were treated; of them, 85% were exclusively managed with surgery. All treated cases were successfully occluded. The incidence in 2021 was significantly higher than that in the prevaccination period (1.72 vs 0.35/100,000/year;p=0.036; 95%Confidence Interval=0.09-2.66). Cohorts were not different in age, sex, hemorrhagic presentation, dural sinus thrombosis or presence of prothrombotic or cardiovascular risk factors. Conclusion The significant increase in the incidence of bDAVF following general vaccination policies against COVID-19 observed in our region suggests a potential correlation between these two facts. Our findings need confirmation from larger cohorts and further pathogenic research.

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“…Polyanion molecules potentially involved in the development of autoimmune HIT are typically bacteria and virus components, hypersulfated chondroitin sulfate, DNA and RNA and polyphosphates. 78 Patients with this syndrome show slightly different clinical features from those with classical HIT, including severe thrombocytopenia (<20x10 9 /L), sometimes in combination with DIC, microvascular thrombosis and CVST in up to 40% of cases. 78 From a therapeutic standpoint, besides the indication for an alternative anticoagulant, valid also for HIT, the intravenous administration of high doses of IgG in combination with steroids has been proposed for autoimmune HIT.…”

Section: The Autoimmune Heparin-induced Thrombocytopenia Hypothesismentioning

confidence: 99%

Interactions of adenoviruses with platelets and coagulation and the vaccine-induced immune thrombotic thrombocytopenia syndrome

et al. 2021

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The Covid-19 pandemic has heavily impacted global health and economy and vaccination remains the primary way of controlling the infection. During the ongoing vaccination campaign some unexpected thrombotic events have emerged in subjects who recently received the AstraZeneca Vaxzevria vaccine or the Johnson&Johnson (Janssen) vaccine, two adenovirus vector-based vaccines. Epidemiological studies confirm that the observed/expected rate of these unusual thromboses is abnormally increased, especially in women in the fertile age. The characteristics of this complication, with venous thromboses at unusual sites, most frequently cerebral vein sinus but also splanchnic, often multiple associated thromboses, thrombocytopenia, and sometimes disseminated intravascular coagulation, are unique and the time course and tumultuous evolution are suggestive of an acute immunological reaction, and indeed platelet-activating anti-PF4 antibodies have been detected in a large fraction of the affected patients. Several data suggest that adenoviruses may interact with platelets, the endothelium and the blood coagulation system. Here we review the interactions between adenoviral vectors and the haemostatic system of possible relevance for the vaccine associated thrombotic thrombocytopenia syndrome, we analyse systematically the clinical data on the reported thrombotic complications of adenovirus-based therapeutics and discuss all the current hypotheses on the mechanisms triggering this novel syndrome. Although considering current evidence the benefit of vaccination clearly outweighs the potential risks, it is of paramount importance to fully unravel the mechanisms leading to the vaccine associated thrombotic thrombocytopenia syndrome and to identify prognostic factors through further research.

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Spontaneous HIT syndrome: Knee replacement, infection, and parallels with vaccine-induced immune thrombotic thrombocytopenia

Cited by 81 publications

References 112 publications

Vaccine‐induced immune thrombotic thrombocytopenia with ChAdOx1 nCoV‐19 is rare in Asia

Vaccine‐induced immune thrombotic thrombocytopenia with ChAdOx1 nCoV‐19 is rare in Asia

Brain Dural Arteriovenous Fistulas in the Covid-19 era: a warning and rationale for association

Interactions of adenoviruses with platelets and coagulation and the vaccine-induced immune thrombotic thrombocytopenia syndrome

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