Clinical Pharmacology and Therapeutics Section, St George's University of London, London, UK.
Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George's University Hospitals NHS Foundation Trust, London, UK.
Br J Clin Pharmacol. 2022 Feb;88(4):1935-1941. doi: 10.1111/bcp.15116. Epub 2021 Nov 9.
The ChAdOx1 nCoV-19 vaccine has been associated with increased risk of thrombosis. Understanding of the management of these rare events is evolving, and currently recommended treatments include human normal immunoglobulin and nonheparin anticoagulation such as direct oral anticoagulants. Our report describes three consecutive patients presenting to a London teaching hospital with vaccine-induced thrombotic thrombocytopenia (VITT), also referred to as vaccine-induced prothrombotic immune thrombocytopenia. The patients ranged in age from 40 to 54 years and two had no known previous medical comorbidities. Two patients had cerebral venous sinus thrombosis and one had a deep vein thrombosis. Two were treated with anticoagulation, one with oral rivaroxaban and the other with an intravenous argotraban infusion that was later converted to oral apixaban. One patient received three doses of human normal immunoglobulin and 5 days of therapeutic plasma exchange. This case series may be used to improve understanding of the clinical course and management of VITT.
腺病毒载体新冠疫苗与血栓形成风险增加相关。目前对这些罕见事件的处理方法还在不断发展，推荐的治疗方法包括人血普通免疫球蛋白和非肝素抗凝剂，如直接口服抗凝剂。本报告描述了三例连续就诊于伦敦教学医院的疫苗诱导的血栓性血小板减少症（VITT）患者，也称为疫苗诱导的促血栓免疫性血小板减少症。患者年龄在 40 至 54 岁之间，其中两人无已知既往合并症。两名患者患有脑静脉窦血栓形成，一名患有深静脉血栓形成。两名患者接受抗凝治疗，一名患者口服利伐沙班，另一名患者静脉输注阿加曲班，随后转换为口服阿哌沙班。一名患者接受了三剂人血普通免疫球蛋白和 5 天的治疗性血浆置换。本病例系列可用于提高对 VITT 的临床过程和管理的认识。
