Long-term follow-up after successful treatment of vaccine-induced prothrombotic immune thrombocytopenia

Johannes Thaler, Petra Jilma, Nazanin Samadi, Florian Roitner, Eva Mikušková, Stephan Kudrnovsky-Moser, Joachim Rettl, Raphael Preiss, Peter Quehenberger, Ingrid Pabinger, Paul Knoebl, Cihan Ay

Research output: Journal article (peer-reviewed)Journal article

12 Citations (Scopus)

Abstract

BACKGROUND: Cases of ChAdOx1 nCoV-19 (AstraZeneca) vaccinated patients with thrombocytopenia, elevated D-dimer, and elevated platelet factor 4 (PF4) antibody levels with- and without thrombosis have been reported. No recommendations regarding the duration of anticoagulation have been made, because data on the long-term course beyond the first weeks is lacking.

OBJECTIVE: To report on the treatment, medical course, and longitudinal follow-up of laboratory parameters in patients with vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).

PATIENTS: We followed VIPIT patients with- (n = 3) and without (n = 3) venous thromboembolism fulfilling the aforementioned laboratory criteria.

RESULTS: Elevated D-dimer (median: 35.10 μg/ml, range: 17.80-52.70), thrombocytopenia (42 G/l, 20-101), and strong positivity in the platelet factor 4 (PF4)/heparin-enzyme-immunoassay (2.42 optical density [OD], 2.06-3.13; reference range < 0.50) were present in all patients after vaccination (10 days, 7-17). Routine laboratory parameters rapidly improved upon initiation of treatment (comprising therapeutic non-heparin anticoagulation in all patients and high dose immunoglobulins ± corticosteroids in 5 patients). PF4 antibody levels slowly decreased over several weeks. Patients were discharged in good physical health (8 days, 5-13). VIPIT did not recur during follow-up (12 weeks, 8-17). Five of 6 patients fully recovered (in 2 patients thrombosis had resolved, in 1 patient exertional dyspnea persisted).

CONCLUSIONS: Remissions without sequelae can be achieved upon rapid initiation of treatment in patients with VIPIT. Platelet factor 4 antibody levels slowly decreased over several weeks but VIPIT did not recur in any of our patients. Continuation of anticoagulation in VIPIT patients at least until PF4 antibody negativity is reached seems reasonable.

Original languageEnglish
Pages (from-to)126-130
Number of pages5
JournalThrombosis Research
Volume207
Early online date4 Oct 2021
DOIs
Publication statusPublished - Nov 2021

Keywords

  • ChAdOx1 nCoV-19
  • Long-term follow-up
  • PF4 antibody levels
  • Successful treatment
  • Vaccine induced prothrombotic immune thrombocytopenia

ASJC Scopus subject areas

  • Hematology

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