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Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128130

ABSTRACT

Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. From a population of over 20 million eligible vaccine recipients in Australia, over 32 million doses have been administered: 19,600,000 Pfizer BNT162b2 (BNT), 12,600,000 AstraZeneca ChAdOx1 nCoV-19 (ChAd), and 397,000 Moderna mRNA-1273. Aim(s): Describe a comprehensive series of ITP after vaccination with clinical outcomes. Method(s): After obtaining IRB approval (2021/ETH00723), we collected data on all ITP cases diagnosed by haematologists in Australia within six weeks of any COVID-19 vaccination. We analysed their outcomes using international consensus definitions of responses and WHO bleeding. Result(s): Demographics (n = 50), treatments, and platelet outcomes (Figures A and B). Bleeding was mostly minor: 35/50 (70%) WHO score <2. Compared to relapses of prior ITP, new presentations of ITP were significantly associated with ChAd over BNT (OR 7.1: 95% CI 1.7 to 25.7, p = 0.0124*). Most patients responded quickly and deeply: Median TTR 4 days (IQR 2-7), median TTCR 7 days (IQR 4-19), overall RR 45/47 (96%), and CR 40/45 (89%). Gender, age, antecedent influenza vaccination and severity of thrombocytopenia had no significant impact on: Bleeding at presentation, response rates, relapse rates, time to response, or the need for ongoing treatments at day 90. No patients presented with thrombosis. PF4 ELISA was positive in one of 18 cases after ChAd (functional testing was negative). Conclusion(s): We diagnosed ITP more frequently after ChAd than BNT vaccination, occurring de novo after 1st doses. Ascertainment bias cannot be excluded due to greater scrutiny for platelet related complications, but almost all patients in this cohort needed treatment. Standard first-line treatments for ITP are highly effective for both de novo and prior ITP (96%), but second-line therapies are often required (34%). Our data reaffirms the safety of vaccinating patients with pre-existing ITP, as bleeding is mild (92% WHO < 2) and platelets respond quickly (TTCR 5 days).

2.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128129

ABSTRACT

Background: As a severe, though rare complication of COVID-19 vaccination, vaccine induced immune thrombotic thrombocytopenia (VITT) emerged in 2021 as a public health issue affecting vaccine confidence. Australia pre-emptively instituted a nationally coordinated system for diagnosis and management incorporating state based immunoassays (ELISA) for PF4 antibodies and national centralised functional testing using three functional assays. Aim(s): To evaluate the triage strategy based upon clinical presentation, thrombocytopenia and D-Dimer used to direct VITT testing. Method(s): Consecutive cases presenting between April 1 and June 11, 2021 referred for VITT testing in Australia were assessed regarding clinical classification, immune-assay and functional assay results, thromboses and mortality according to triage category (Table 1). Functional testing proceeded for all triaged as Probable VITT , ELISA positive and unusual site thromboses positive patients if triaged Less likely , and only for quality assurance purposes if Much less likely VITT . Anti-PF4 antibodies were measured by IgG-specific ELISA (Asserachrom, Stago Diagnostics). Platelet-activating antibodies were assayed using whole blood procoagulant platelet flow cytometry assay (Lee et al), PF4-serotonin release assay or multiplate multiple electrode aggregation. Result(s): 92% of 52 patients with a final diagnosis of VITT supported by a positive antibody assay (immunological or functional) were triaged prior to VITT specific testing into the high probability category. 100% ELISA positive individuals within the high and intermediate clinical probability groups were supported by detection of a platelet activating antibody using a functional assay and 0% in the low probability group. 16% of clinical VITT patients without confirmation of anti-PF4 antibodies by ELISA had VITT diagnosis supported by functional assay in a final clinico-pathological adjudication. Conclusion(s): Triage of testing according to clinical probability of VITT based on clinical criteria and standard laboratory tests was helpful in directing testing in resource constrained period. Demonstration of platelet activating antibodies in functional assays significantly contributes to definition of the VITT syndrome. (Table Presented).

3.
International Journal of Stroke ; 17(2 Supplement):8-9, 2022.
Article in English | EMBASE | ID: covidwho-2079342

ABSTRACT

Background: The COVID-19 pandemic has disrupted modern healthcare and delayed time to acute stroke treatment at some centres internationally. The effect of the pandemic on time metrics in patients with a large vessel occlusion (LVO) at Australian stroke centres is unknown. Aim(s): To evaluate time metrics for patients with an LVO transferred from a primary stroke centre (PSC) to a comprehensive stroke centre (CSC), during and before the coronavirus pandemic. Method(s): Retrospective analysis of consecutive patients with an LVO who were transferred from a single PSC to any of three CSCs were enrolled. The pandemic period was defined as the 24 months following the March 2020 state of emergency declaration in Melbourne, and prepandemic period the preceding 24 months. "Door-in" was the time triaged as a stroke, and "Door-out" was the time ambulance staff departed. Result(s): 159 patients were included, 82 in the pandemic group and 77 in the pre-pandemic group. There were no significant differences between groups in patient age, sex, modified Rankin scale score, or National Institute of Health Stroke Scale score. Door-in to Door-out (DIDO) times were reduced during the pandemic (median 52 vs 66 minutes, IQR 41-66 vs 52-95 minutes, p<0.001). There was no change in time from PSC Door-in to the first CSC DSA images (median 125 vs 125 minutes, p=0.79). Within the DIDO workflow, the only significantly different metric was time from CSC advising of patient acceptance to PSC door-out, which improved (median 8 vs 14 minutes, p=0.016). DIDO times out of hours when the stroke registrar was called in also improved (median 51 vs 87 minutes, p=0.003). Conclusion(s): The median DIDO times at our PSC improved during the pandemic. Further studies are required to determine if this is due to a continued quality improvement program at our centre, or due to other factors.

4.
2nd ACM Conference on Information Technology for Social Good, GoodIT 2022 ; : 300-307, 2022.
Article in English | Scopus | ID: covidwho-2053345

ABSTRACT

Despite substantial advancements in healthcare systems and management, little progress has been achieved in addressing supply chain constraints such as, inefficient purchasing, ordering, predicting, and administration procedures. Healthcare authorities needs to effectively manage the healthcare supply chain processes not just during pandemics like COVID-19, but also in their everyday operations to guarantee best possible services. Product recalls, product supply shortage monitoring, expiry, and counterfeiting are some of the critical healthcare supply chain operations which must be ensured. Our suggested solution combines blockchain technology and distributed storage to increase transparency, improve stakeholder communication, and shorten product procurement timelines while eliminating crucial disparities and faults. We present a generic framework for the healthcare supply chain, equipped with comprehensive algorithms showing various stakeholder interactions. Our system uses the Ethereum network to link all parties, including the healthcare authority, manufacturer, wholesaler, retailer, and healthcare provider. Remix IDE platform was used to develop and test the smart contract codes. As decentralized storage, we have used the combination of InterPlanetary File System (IPFS) and Hyperledger Fabric. We have also examined a variety of security issues, provided a cost analysis of the various transactions proposed in our solution while making comparison with similar blockchain-based solutions. © 2022 Owner/Author.

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