Thrombotic Complications after COVID-19 Vaccination: Diagnosis and Treatment Options

Abstract

Coronavirus disease 2019 (COVID-19) vaccines were developed a few months after the emergence of the pandemic. The first cases of vaccine-induced thrombotic complications after the use of adenoviral vector vaccines ChAdOx1 nCoV-19 by AstraZeneca, and Ad26.COV2.S by Johnson & Johnson/Janssen, were announced shortly after the initiation of a global vaccination program. In these cases, the occurrence of thrombotic events at unusual sites-predominantly located in the venous vascular system-in association with concomitant thrombocytopenia were observed. Since this new entity termed vaccine-induced thrombotic thrombocytopenia (VITT) shows similar pathophysiologic mechanisms as heparin-induced thrombocytopenia (HIT), including the presence of antibodies against heparin/platelet factor 4 (PF4), standard routine treatment for thrombotic events-arterial or venous-are not appropriate and may also cause severe harm in affected patients. Thrombotic complications were also rarely documented after vaccination with mRNA vaccines, but a typical VITT phenomenon has, to date, not been established for these vaccines. The aim of this review is to give a concise and feasible overview of diagnostic and therapeutic strategies in COVID-19 vaccine-induced thrombotic complications.

Keywords: (autoimmune) heparin-induced thrombocytopenia (HIT); adenoviral vector vaccines; anticoagulation; coronavirus disease 2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thrombosis; thrombosis thrombocytopenia syndrome (TTS); vaccination; vaccine-induced thrombotic thrombocytopenia (VITT).

Figure 1

Diagnostic algorithm for vaccine-induced thrombotic thrombocytopenia (modified from ISTH [63]).

Figure 2

Therapeutic recommendations for vaccine-induced thrombotic thrombocytopenia (modified from ISTH [63]).