Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Int J Infect Dis. 2022 Jun;119:130-139. doi: 10.1016/j.ijid.2022.03.034. Epub 2022 Mar 24.
To meta-analyse the clinical manifestations, diagnosis, treatment, and mortality of vaccine-induced immune thrombotic thrombocytopenia (VITT) after adenoviral vector vaccination.
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.
The incidence of total venous thrombosis after ChAdOx1 nCoV-19 vaccination was 28 (95% CI 12-52, I=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, I=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, I=0%) and the overall mortality was 32% (95% CI 24-41, I=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, I=0%).
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.
对腺病毒载体疫苗接种后疫苗诱导的免疫性血栓性血小板减少症（VITT）的临床表现、诊断、治疗和死亡率进行荟萃分析。
从 PubMed、Scopus、Embase 和 Web of Science 中回顾了 18 项关于 ChAdOx1 nCoV-19 或 Ad26.COV2.S 疫苗接种后发生的 VITT 的研究。荟萃分析估计了关于发病率、表现、血栓形成部位、诊断发现和临床结局的汇总效应和研究间异质性。
ChAdOx1 nCoV-19 疫苗接种后总静脉血栓形成的发生率为每 100,000 剂 28 例（95%CI 12-52，I=100%）。在纳入定量分析的 664 例患者（10 项研究）中，VITT 患者的平均年龄为 45.6 岁（95%CI 43.8-47.4，I=57%），女性居多（70%）。VITT 患者中分别有 54%、36%和 19%发生脑静脉血栓形成（CVT）、深静脉血栓形成（DVT）/肺血栓栓塞症（PE）和脾静脉血栓形成。ChAdOx1 nCoV-19 疫苗接种后 CVT 的累积发生率（23 例/100,000 人年）高于大流行前普通人群（0.9 例/100,000 人年）报告的发生率。颅内出血和颅外血栓形成分别伴随 CVT 患者的 47%和 33%。抗血小板因子 4 抗体阳性率为 91%（95%CI 88-94，I=0%），总死亡率为 32%（95%CI 24-41，I=69%），肝素和非肝素抗凝治疗之间无显著差异（风险比 0.84，95%CI 0.47-1.50，I=0%）。
SARS-CoV-2 疫苗接种后发生 VITT 的患者最常表现为 DVT/PE 后 CVT 和脾静脉血栓形成，约 1/3 的患者有致命结局。本荟萃分析应能更好地了解 VITT，并帮助临床医生早期识别 VITT，以改善结局并优化管理。
