Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination
| Autor: | Marie Scully, William John Thomas, David Goldblatt, Anthony Poles, Robert Lown, Tom Solomon, Deepak Singh, Pavel Kotoucek, William Lester, Marcel Levi |
|---|---|
| Přispěvatelé: | Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Atherosclerosis & ischemic syndromes |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty COVID-19 Vaccines viruses 030204 cardiovascular system & hematology Antibodies Viral Platelet Factor 4 03 medical and health sciences 0302 clinical medicine Medical microbiology ChAdOx1 nCoV-19 Pandemic Epidemiology medicine Humans 030212 general & internal medicine Aged Autoantibodies biology business.industry Heparin Autoantibody virus diseases Anticoagulants COVID-19 Thrombosis General Medicine Middle Aged medicine.disease Flow Cytometry Thrombocytopenia body regions Vaccination Immunology biology.protein Female Antibody business Platelet factor 4 Algorithms |
| Zdroj: | NEW ENGLAND JOURNAL OF MEDICINE New England journal of medicine, 384(23), 2202-2211. Massachussetts Medical Society |
| ISSN: | 0028-4793 |
| Popis: | BACKGROUND The mainstay of control of the coronavirus disease 2019 (Covid-19) pandemic is vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a year, several vaccines have been developed and millions of doses delivered. Reporting of adverse events is a critical postmarketing activity. METHODS We report findings in 23 patients who presented with thrombosis and thrombocytopenia 6 to 24 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca). On the basis of their clinical and laboratory features, we identify a novel underlying mechanism and address the therapeutic implications. RESULTS In the absence of previous prothrombotic medical conditions, 22 patients presented with acute thrombocytopenia and thrombosis, primarily cerebral venous thrombosis, and 1 patient presented with isolated thrombocytopenia and a hemorrhagic phenotype. All the patients had low or normal fibrinogen levels and elevated d-dimer levels at presentation. No evidence of thrombophilia or causative precipitants was identified. Testing for antibodies to platelet factor 4 (PF4) was positive in 22 patients (with 1 equivocal result) and negative in 1 patient. On the basis of the pathophysiological features observed in these patients, we recommend that treatment with platelet transfusions be avoided because of the risk of progression in thrombotic symptoms and that the administration of a nonheparin anticoagulant agent and intravenous immune globulin be considered for the first occurrence of these symptoms. CONCLUSIONS Vaccination against SARS-CoV-2 remains critical for control of the Covid-19 pandemic. A pathogenic PF4-dependent syndrome, unrelated to the use of heparin therapy, can occur after the administration of the ChAdOx1 nCoV-19 vaccine. Rapid identification of this rare syndrome is important because of the therapeutic implications. |
| Databáze: | OpenAIRE |
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