VITT

So much talk about blood clots this week! I teamed up with @deplatformdisease to try and give a detailed look at what we know about the clinical presentation seen in a very small population of adenovirus-based vaccine recipients and what we know about the molecular biology. It is important to recognize that because this is so incredibly rare, there are really only hypotheses on how this is occurring as opposed to clean and proven mechanisms of action. Most importantly, the way to diagnose the specific clot, paired with thrombocytopenia, has become clear, which means that specific treatment can be started immediately.

(Sources in the comments)

1. Hoffman R, Benz EJ, Heslop H, Silberstein LE, Weitz J, Anastasi J. Hematology: Basic principles and practice. 7th ed. Philadelphia, PA: Elsevier – Health Sciences Division; 2017.

2. Shimabukuro T. Reports of cerebral venous sinus thrombosis with thrombocytopenia after Janssen COVID-19 vaccine Advisory Committee on Immunization Practices (ACIP) April 14, 2021 [Internet]. Cdc.gov. [cited 2021 Apr 17];Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-04/03-COVID-Shimabukuro-508.pdf

3. Ad26COV2.S Vaccine Janssen ACIP Presentation 14 April 2021 [Internet]. Cdc.gov. [cited 2021 Apr 17];Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-04/02-COVID-Janssen-508.pdf

4. Arepally GM, Padmanabhan A. Heparin-induced thrombocytopenia: A focus on thrombosis. Arterioscler Thromb Vasc Biol [Internet] 2020;Available from: http://dx.doi.org/10.1161/atvbaha.120.315445

5. Schultz NH, Sørvoll IH, Michelsen AE, et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination. N Engl J Med [Internet] 2021;(NEJMoa2104882). Available from: http://dx.doi.org/10.1056/NEJMoa2104882

6. Brunton L, Knollman B, Hilal-Dandan R. Goodman and gilman’s the pharmacological basis of therapeutics, 13th edition. 13th ed. McGraw-Hill Education/Medical; 2017.

7. Sadoff J, Davis K, Douoguih M. Thrombotic thrombocytopenia after Ad26.COV2.S vaccination — response from the manufacturer. N Engl J Med [Internet] 2021;(NEJMc2106075). Available from: http://dx.doi.org/10.1056/nejmc2106075

8. Muir K-L, Kallam A, Koepsell SA, Gundabolu K. Thrombotic thrombocytopenia after Ad26.COV2.S vaccination. N Engl J Med [Internet] 2021;(NEJMc2105869). Available from: http://dx.doi.org/10.1056/nejmc2105869

9. Zheng Y, Zhu W, Haribhai D, et al. Regulatory T cells control PF4/heparin antibody production in mice. J Immunol 2019;203(7):1786–92.

10. Scully M, Singh D, Lown R, et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination. N Engl J Med [Internet] 2021;(NEJMoa2105385). Available from: http://dx.doi.org/10.1056/nejmoa2105385

11. Zheng Y, Wang AW, Yu M, et al. B-cell tolerance regulates production of antibodies causing heparin-induced thrombocytopenia. Blood 2014;123(6):931–4.

12. Greinacher A. Heparin-induced thrombocytopenia. N Engl J Med 2015;373(3):252–61.

13. Farkas J. Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin [Internet]. Emcrit.org. [cited 2021 Apr 17];Available from: https://emcrit.org/ibcc/heparin/#:~:text=LMWH%20is%20easier%20to%20give,effective%20and%20causes%20less%20bleeding.

14. Tattersall TL, Thangasamy IA, Reynolds J. Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene. BMJ Case Rep 2014;2014(oct14 1):bcr2014206070–bcr2014206070.

15. Nicolas D, Nicolas S, Hodgens A, Reed M. Heparin Induced Thrombocytopenia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.

16. José M Ferro PC. Cerebral venous thrombosis: Etiology, clinical features, and diagnosis [Internet]. Uptodate.com. [cited 2021 Apr 17];Available from: https://www.uptodate.com/contents/cerebral-venous-thrombosis-etiology-clinical-features-and-diagnosis

Posted on Instagram on April 17, 2021.

Leave a Reply

Discover more from Science With Anni

Subscribe now to keep reading and get access to the full archive.

Continue reading