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COVID-19 vaccines and thrombosis with thrombocytopenia syndrome
Expert Review of Vaccines ( IF 6.2 ) Pub Date : 2021-07-08 , DOI: 10.1080/14760584.2021.1949294
Chih-Cheng Lai, Wen-Chien Ko, Chih-Jung Chen, Po-Yen Chen, Yhu-Chering Huang, Ping-Ing Lee, Po-Ren Hsueh

ABSTRACT

Introduction

To combat COVID-19, scientists all over the world have expedited the process of vaccine development. Although interim analyses of clinical trials have demonstrated the efficacy and safety of COVID-19 vaccines, a serious but rare adverse event, thrombosis with thrombocytopenia syndrome (TTS), has been reported following COVID-19 vaccination.

Areas covered

This review, using data from both peer-reviewed and non-peer-reviewed studies, aimed to provide updated information about the critical issue of COVID-19 vaccine-related TTS.

Expert opinion

: The exact epidemiological characteristics and possible pathogenesis of this adverse event remain unclear. Most cases of TTS developed in women within 2 weeks of the first dose of vaccine on the receipt of the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines. In countries with mass vaccination against COVID-19, clinicians should be aware of the relevant clinical features of this rare adverse event and perform related laboratory and imaging studies for early diagnosis. Non-heparin anticoagulants, such as fondaparinux, argatroban, or a direct oral anticoagulant (e.g. apixaban or rivaroxaban) and intravenous immunoglobulins are recommended for the treatment of TTS. However, further studies are required to explore the underlying mechanisms of this rare clinical entity.

Plain language summary

What is the context?

Thrombosis with thrombocytopenia syndrome (TTS) usually develops within 2 weeks of the first doses of the ChAdOx1 nCoV-19 and Ad26.COV2.S COVID-19 vaccines.TTS mainly occurs in patients aged < 55 years and is associated with high morbidity and mortality.

What is new?

TTS mimics autoimmune heparin-induced thrombocytopenia and can be mediated by platelet-activating antibodies against platelet factor 4. Non-heparin anticoagulants, such as fondaparinux, argatroban, or a direct oral anticoagulant (e.g. apixaban or rivaroxaban) should be considered as the treatment of choice if the platelet count is > 50 × 109/L and there is no serious bleeding. Intravenous immunoglobulins and glucocorticoids may help increase the platelet count within days and reduce the risk of hemorrhagic transformation when anticoagulation is initiated.

What is the impact?

TTS should be a serious concern during the implementation of mass COVID-19 vaccination, and patients should be educated about this complication along with its symptoms such as severe headache, blurred vision, seizure, severe and persistent abdominal pain, painful swelling of the lower leg, and chest pain or dyspnea. The incidence of TTS is low; therefore, maintenance of high vaccination coverage against COVID-19 should be continued.



中文翻译:

COVID-19疫苗和血栓形成伴血小板减少综合征

摘要

介绍

为了对抗 COVID-19,世界各地的科学家都加快了疫苗开发的进程。尽管临床试验的中期分析已经证明了 COVID-19 疫苗的有效性和安全性,但在 COVID-19 疫苗接种后报告了一种严重但罕见的不良事件,即血小板减少综合征(TTS)血栓形成。

覆盖区域

本综述使用来自同行评审和非同行评审研究的数据,旨在提供有关 COVID-19 疫苗相关 TTS 关键问题的最新信息。

专家意见

:这一不良事件的确切流行病学特征和可能的发病机制尚不清楚。大多数 TTS 病例是在接受 ChAdOx1 nCoV-19 和 Ad26.COV2.S 疫苗后接种第一剂疫苗后 2 周内在女性身上发生的。在大规模接种 COVID-19 疫苗的国家,临床医生应了解这种罕见不良事件的相关临床特征,并进行相关实验室和影像学研究以进行早期诊断。推荐使用非肝素抗凝剂,如磺达肝素、阿加曲班或直接口服抗凝剂(如阿哌沙班或利伐沙班)和静脉注射免疫球蛋白来治疗 TTS。然而,需要进一步的研究来探索这种罕见的临床实体的潜在机制。

简明语言摘要

上下文是什么?

血栓形成与血小板减少综合征 (TTS) 通常在首次接种 ChAdOx1 nCoV-19 和 Ad26.COV2.S COVID-19 疫苗后 2 周内发生。TTS 主要发生在<55 岁的患者中,并且与高发病率和死亡率相关.

什么是新的?

TTS 模拟自身免疫性肝素诱导的血小板减少症,可以由抗血小板因子 4 的血小板激活抗体介导。 应考虑使用非肝素抗凝剂,如磺达肝素、阿加曲班或直接口服抗凝剂(如阿哌沙班或利伐沙班)治疗如果血小板计数> 50 × 10 9 /L 且没有严重出血,则选择。静脉注射免疫球蛋白和糖皮质激素可能有助于在数天内增加血小板计数,并在开始抗凝治疗时降低出血转化的风险。

有什么影响?

在实施大规模 COVID-19 疫苗接种期间,TTS 应该是一个严重的问题,并且应该教育患者了解这种并发症及其症状,例如严重的头痛、视力模糊、癫痫发作、严重和持续的腹痛、小腿疼痛性肿胀,以及胸痛或呼吸困难。TTS的发生率低;因此,应继续维持针对 COVID-19 的高疫苗接种覆盖率。

更新日期:2021-09-07
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