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Thrombosis patterns and clinical outcome of COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A Systematic Review and Meta-Analysis

Authors
 Ah Young Kim  ;  Wongi Woo  ;  Dong Keon Yon  ;  Seung Won Lee  ;  Jae Won Yang  ;  Ji Hong Kim  ;  Seoyeon Park  ;  Ai Koyanagi  ;  Min Seo Kim  ;  Sungsoo Lee  ;  Jae Il Shin  ;  Lee Smith 
Citation
 INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol.119 : 130-139, 2022-06 
Journal Title
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ISSN
 1201-9712 
Issue Date
2022-06
MeSH
Ad26COVS1 ; COVID-19 Vaccines / adverse effects ; COVID-19* / prevention & control ; ChAdOx1 nCoV-19 ; Female ; Humans ; Male ; Middle Aged ; Purpura, Thrombocytopenic, Idiopathic* / epidemiology ; Purpura, Thrombocytopenic, Idiopathic* / etiology ; SARS-CoV-2 ; Thrombocytopenia* / etiology ; Thrombosis* / epidemiology ; Thrombosis* / etiology ; Vaccines* ; Venous Thrombosis* / chemically induced ; Venous Thrombosis* / etiology
Keywords
COVID-19 vaccine ; adverse event ; cerebral venous thrombosis ; splanchnic vein thrombosis ; vaccine thrombosis ; vaccine-induced immune thrombotic thrombocytopenia.
Abstract
Objectives: To meta-analyse the clinical manifestations, diagnosis, treatment, and mortality of vaccine-induced immune thrombotic thrombocytopenia (VITT) after adenoviral vector vaccination.

Methods: Eighteen studies of VITT after ChAdOx1 nCoV-19 or Ad26.COV2.S vaccine administration were reviewed from PubMed, Scopus, Embase, and Web of Science. The meta-analysis estimated the summary effects and between-study heterogeneity regarding the incidence, manifestations, sites of thrombosis, diagnostic findings, and clinical outcomes.

Results: The incidence of total venous thrombosis after ChAdOx1 nCoV-19 vaccination was 28 (95% CI 12-52, I2=100%) per 100,000 doses administered. Of 664 patients included in the quantitative analysis (10 studies), the mean age of patients with VITT was 45.6 years (95% CI 43.8-47.4, I2=57%), with a female predominance (70%). Cerebral venous thrombosis (CVT), deep vein thrombosis (DVT)/pulmonary thromboembolism (PE), and splanchnic vein thrombosis occurred in 54%, 36%, and 19% of patients with VITT, respectively. The pooled incidence rate of CVT after ChAdOx1 nCoV-19 vaccination (23 per 100,000 person-years) was higher than that reported in the pre-pandemic general population (0.9 per 100,000 person-years). Intracranial haemorrhage and extracranial thrombosis accompanied 47% and 33% of all patients with CVT, respectively. The antiplatelet factor 4 antibody positivity rate was 91% (95% CI 88-94, I2=0%) and the overall mortality was 32% (95% CI 24-41, I2=69%), and no significant difference was observed between heparin- and non-heparin-based anticoagulation treatments (risk ratio 0.84, 95% CI 0.47-1.50, I2=0%).

Conclusions: Patients with VITT after SARS-CoV-2 vaccination most frequently presented with CVT following DVT/PE and splanchnic vein thrombosis, and about one-third of patients had a fatal outcome. This meta-analysis should provide a better understanding of VITT and assist clinicians in identifying VITT early to improve outcomes and optimise management.
Files in This Item:
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DOI
10.1016/j.ijid.2022.03.034
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ah Young(김아영) ORCID logo https://orcid.org/0000-0002-0713-4461
Kim, Ji Hong(김지홍) ORCID logo https://orcid.org/0000-0001-5352-5423
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
Lee, Sung Soo(이성수) ORCID logo https://orcid.org/0000-0001-8998-9510
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188856
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