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Review
. 2022 Mar;32(2):e2273.
doi: 10.1002/rmv.2273. Epub 2021 Jul 1.

Vaccine-induced immune thrombotic thrombocytopenia after vaccination against Covid-19: A clinical dilemma for clinicians and patients

Zeinab Mohseni Afshar  1 , Arefeh Babazadeh  2 , Alireza Janbakhsh  1 , Mandana Afsharian  1 , Kiarash Saleki  3   4 , Mohammad Barary  3   4 , Soheil Ebrahimpour  2
Affiliations
Review

Vaccine-induced immune thrombotic thrombocytopenia after vaccination against Covid-19: A clinical dilemma for clinicians and patients

Zeinab Mohseni Afshar et al. Rev Med Virol. 2022 Mar.

Abstract

The coronavirus disease 2019 (Covid-19) pandemic has had devastating effects on public health worldwide, but the deployment of vaccines for Covid-19 protection has helped control the spread of SARS Coronavirus 2 (SARS-CoV-2) infection where they are available. The common side effects reported following Covid-19 vaccination were mostly self-restricted local reactions that resolved quickly. Nevertheless, rare vaccine-induced immune thrombotic thrombocytopenia (VITT) cases have been reported in some people being vaccinated against Covid-19. This review summarizes the thromboembolic events after Covid-19 vaccination and discusses its molecular mechanism, incidence rate, clinical manifestations and differential diagnosis. Then, a step-by-step algorithm for diagnosing such events, along with a management plan, are presented. In conclusion, considering the likeliness of acquiring severe SARS-CoV-2 infection and its subsequent morbidity and mortality, the benefits of vaccination outweigh its risks. Hence, if not already initiated, all governments should begin an effective and fast public vaccination plan to overcome this pandemic.

Keywords: CSVT; Covid-19; PVT; SARS-CoV-2; Thrombosis; VIPIT; VITT; Vaccination.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Possible link of different Covid‐19 vaccines with thrombotic and thrombocytopenia events. Structure type and platform for four SARS‐CoV2 vaccines have been provided. Although more studies are required to reach a common point, thrombotic events have been reported for several specific vaccines but not for others. Prothrombotic thrombocytopathy mimicking heparin‐induced thrombocytopenia has been found in severe cases of Covid‐19 and after vaccination with some vaccines. This process may involve ACE2 and CD147, SARS‐CoV2 receptors. PGs and PF4 from platelets interact with B cells. Next, produced antibodies bind the endothelial surface (RCSB.org; PDB ID: 3QQN). ACE2, angiotensin‐converting enzyme 2; CD, cluster of differentiation; nCoV, novel coronavirus; PF4, platelet factor 4; PG, proteoglycan; SARS‐CoV2, severe acute respiratory syndrome coronavirus 2. Created with BioRender.com
FIGURE 2
FIGURE 2
A step‐by‐step algorithm for diagnosing VIPIT, which is now changed to VITT (Courtesy of 2021 Ontario Covid‐19 Science Advisory Table 46 ). VIPIT, vaccine‐induced prothrombotic immune thrombocytopenia; VITT, vaccine‐induced immune thrombotic thrombocytopenia
See this image and copyright information in PMC

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