Your browser doesn't support javascript.
Thrombosis patterns and clinical outcome of COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A Systematic Review and Meta-Analysis.
Kim, Ah Young; Woo, Wongi; Yon, Dong Keon; Lee, Seung Won; Yang, Jae Won; Kim, Ji Hong; Park, Seoyeon; Koyanagi, Ai; Kim, Min Seo; Lee, Sungsoo; Shin, Jae Il; Smith, Lee.
  • Kim AY; Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
  • Woo W; Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • Yon DK; Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea.
  • Lee SW; Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea; Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea.
  • Yang JW; Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
  • Kim JH; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
  • Park S; Yonsei University College of Medicine, Seoul, South Korea.
  • Koyanagi A; Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain.
  • Kim MS; Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea.
  • Lee S; Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • Shin JI; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. Electronic address: shinji@yuhs.ac.
  • Smith L; Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK.
Int J Infect Dis ; 119: 130-139, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1889472
ABSTRACT

OBJECTIVES:

To meta-analyse the clinical manifestations, diagnosis, treatment, and mortality of vaccine-induced immune thrombotic thrombocytopenia (VITT) after adenoviral vector vaccination.

METHODS:

Eighteen studies of VITT after ChAdOx1 nCoV-19 or Ad26.COV2.S vaccine administration were reviewed from PubMed, Scopus, Embase, and Web of Science. The meta-analysis estimated the summary effects and between-study heterogeneity regarding the incidence, manifestations, sites of thrombosis, diagnostic findings, and clinical outcomes.

RESULTS:

The incidence of total venous thrombosis after ChAdOx1 nCoV-19 vaccination was 28 (95% CI 12-52, I2=100%) per 100,000 doses administered. Of 664 patients included in the quantitative analysis (10 studies), the mean age of patients with VITT was 45.6 years (95% CI 43.8-47.4, I2=57%), with a female predominance (70%). Cerebral venous thrombosis (CVT), deep vein thrombosis (DVT)/pulmonary thromboembolism (PE), and splanchnic vein thrombosis occurred in 54%, 36%, and 19% of patients with VITT, respectively. The pooled incidence rate of CVT after ChAdOx1 nCoV-19 vaccination (23 per 100,000 person-years) was higher than that reported in the pre-pandemic general population (0.9 per 100,000 person-years). Intracranial haemorrhage and extracranial thrombosis accompanied 47% and 33% of all patients with CVT, respectively. The antiplatelet factor 4 antibody positivity rate was 91% (95% CI 88-94, I2=0%) and the overall mortality was 32% (95% CI 24-41, I2=69%), and no significant difference was observed between heparin- and non-heparin-based anticoagulation treatments (risk ratio 0.84, 95% CI 0.47-1.50, I2=0%).

CONCLUSIONS:

Patients with VITT after SARS-CoV-2 vaccination most frequently presented with CVT following DVT/PE and splanchnic vein thrombosis, and about one-third of patients had a fatal outcome. This meta-analysis should provide a better understanding of VITT and assist clinicians in identifying VITT early to improve outcomes and optimise management.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Vaccines / Purpura, Thrombocytopenic, Idiopathic / Venous Thrombosis / COVID-19 Type of study: Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Female / Humans / Male / Middle aged Language: English Journal: Int J Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Vaccines / Purpura, Thrombocytopenic, Idiopathic / Venous Thrombosis / COVID-19 Type of study: Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Female / Humans / Male / Middle aged Language: English Journal: Int J Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article