COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A review of the potential mechanisms and proposed management

Sci Prog. 2021 Apr-Jun;104(2):368504211025927. doi: 10.1177/00368504211025927.

Abstract

With over 600 million coronavirus (COVID-19) vaccine doses administered globally, adverse events are constantly monitored. Recently however, reports of thrombosis and thrombocytopenia following vaccination with the ChAdOx1 nCoV-19 vaccine have emerged. This paper aims to review the available literature and guidelines pertaining to vaccine-induced immune thrombotic thrombocytopenia (VITT) and the proposed guidelines, while offering a potential approach that unifies the available evidence. While the risk of VITT remains extremely low and the benefits outweigh the risks, experimental studies are needed to clarify the pathophysiology behind VITT and possibly decrease the risk of thrombosis and other adverse events occurring. However, treatment should not be delayed in suspected cases, and IV immunoglobulin and non-heparin anticoagulation should be initiated.

Keywords: COVID-19; ChAdOx1 nCoV-19; TTS; VIPIT; VITT; Vaccine-induced immune thrombotic thrombocytopenia; thrombocytopenia; thrombosis; thrombosis with thrombocytopenia syndrome; vaccine-induced prothrombotic immune thrombocytopenia.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use*
  • Antithrombins / therapeutic use
  • Autoantibodies / blood
  • Biomarkers / blood
  • COVID-19 / epidemiology
  • COVID-19 / immunology
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / adverse effects*
  • ChAdOx1 nCoV-19
  • Factor Xa Inhibitors / therapeutic use
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Fondaparinux / therapeutic use
  • Heparin / adverse effects
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Practice Guidelines as Topic
  • Purpura, Thrombocytopenic, Idiopathic / blood
  • Purpura, Thrombocytopenic, Idiopathic / chemically induced
  • Purpura, Thrombocytopenic, Idiopathic / drug therapy*
  • Purpura, Thrombocytopenic, Idiopathic / pathology
  • SARS-CoV-2 / immunology
  • SARS-CoV-2 / pathogenicity
  • Thrombosis / blood
  • Thrombosis / chemically induced
  • Thrombosis / drug therapy*
  • Thrombosis / pathology

Substances

  • Anticoagulants
  • Antithrombins
  • Autoantibodies
  • Biomarkers
  • COVID-19 Vaccines
  • Factor Xa Inhibitors
  • Fibrin Fibrinogen Degradation Products
  • Immunoglobulins, Intravenous
  • fibrin fragment D
  • Heparin
  • ChAdOx1 nCoV-19
  • Fondaparinux