Thrombotic Complications after COVID-19 Vaccination: Diagnosis and Treatment Options

Abstract

Coronavirus disease 2019 (COVID-19) vaccines were developed a few months after the emergence of the pandemic. The first cases of vaccine-induced thrombotic complications after the use of adenoviral vector vaccines ChAdOx1 nCoV-19 by AstraZeneca, and Ad26.COV2.S by Johnson & Johnson/Janssen, were announced shortly after the initiation of a global vaccination program. In these cases, the occurrence of thrombotic events at unusual sites—predominantly located in the venous vascular system—in association with concomitant thrombocytopenia were observed. Since this new entity termed vaccine-induced thrombotic thrombocytopenia (VITT) shows similar pathophysiologic mechanisms as heparin-induced thrombocytopenia (HIT), including the presence of antibodies against heparin/platelet factor 4 (PF4), standard routine treatment for thrombotic events—arterial or venous—are not appropriate and may also cause severe harm in affected patients. Thrombotic complications were also rarely documented after vaccination with mRNA vaccines, but a typical VITT phenomenon has, to date, not been established for these vaccines. The aim of this review is to give a concise and feasible overview of diagnostic and therapeutic strategies in COVID-19 vaccine-induced thrombotic complications.

The Mysterious Risk of Arterial Thrombosis With COVID-19: A Case Series of Acute Limb Ischaemia in Vaccinated Patients

“…This applies to both the AstraZeneca and Pfizer-BioNTech vaccines. Conversely, there have been reports of thrombosis as a side effect of the vaccines [ 9 ]. This is thought to be caused by soluble adenoviral protein spike variants, leading to endothelial dysfunction and, subsequently, thrombosis [ 10 ].…”

Comparative analysis of antibody responses to BNT162b2, ChAdOx1, and CoronaVac vaccines in the Albanian population over the pandemic years 2021 to 2022

“…Despite their success, misinformation and conspiracy theories spread through social media hindered their broader acceptance, particularly among less informed groups [ 5 ]. Adenoviral vector vaccines also saw extensive use but faced reduced application due to side effects like venous thrombosis [ 6 ]. Traditional vaccines using inactivated viruses were widely administered, but their effectiveness was comparatively lower, notably against Delta and Omicron variants [ 7 8 ].…”

Beyond mental stress-induced myocardial ischemia following the COVID-19 vaccine

“…First, thrombosis with thrombocytopenia syndrome (TTS), a new clinical entity associated with adenovirus-vectored vaccines, is a severe and life-threatening complication [ 6 , 7 ]. TTS after COVID-19 vaccination mimics the clinical image of autoimmune heparin-induced thrombocytopenia, which involves the formation of anti-PF4 antibodies and the activation of platelets, leading to thrombocytopenia and thrombin-mediated clotting [ 6 ].…”

“…TTS after COVID-19 vaccination mimics the clinical image of autoimmune heparin-induced thrombocytopenia, which involves the formation of anti-PF4 antibodies and the activation of platelets, leading to thrombocytopenia and thrombin-mediated clotting [ 6 ]. Cerebral venous thrombosis, which encompasses thrombosis in dural sinus veins, cortical veins, and deep venous structures, is potentially the most serious form of TTS [ 7 ]. Although most reported cases developed within two weeks after adenovirus-vectored vaccines, TTS were also rarely documented after vaccination with mRNA vaccines [ 6 ].…”

“…Non-heparin anticoagulant or a direct oral anticoagulant with intravenous immunoglobulins is the standard treatment. Additionally, systemic corticosteroid or plasma exchange could be recommended if clinically indicated [ 7 ].…”