Departamento de Ciencias de la Salud, Universidad de Sonora, México.
Departamento de Ciencias de la Salud, Universidad de Sonora, México.
Arch Med Res. 2022 Jun;53(4):341-351. doi: 10.1016/j.arcmed.2022.03.008. Epub 2022 May 6.
Development of thrombocytopenia and thrombosis after administration of the ChAdox1 nCoV-19 (AstraZeneca-Oxford) vaccine has recently been described. This new condition is called vaccine-induced immune thrombotic thrombocytopenia (VITT). Our objective was to summarize case reports on VITT with/without D-dimer increments in AstraZeneca-Oxford vaccinated individuals.
MEDLINE, PubMed, and Scopus databases were searched.
Case series, case reports, letters to the editor; and abstracts of AstraZeneca-Oxford vaccinated patients with a clinical profile of thrombocytopenia (platelet count <150X10 3 /dL) and D-dimer determination, with or without thrombosis, and/or bleeding, and/or antibodies against platelet factor 4 (aPF4), were included.
Baseline risk factors, symptoms, physical signs; laboratory results, imaging findings, treatment; and outcome in patients with VITT reported in case series, were examined.
Patients who developed VITT were more likely to be young women (ages 21 to 77) given the AstraZeneca-Oxford vaccine 5-14 days prior to presentation. Patients' signs, symptoms, and imaging findings were consistent with cerebral venous sinus thrombosis, or deep veins, lung, and other sites. Laboratory findings showed thrombocytopenia, low fibrinogen, and elevated D-dimer levels, while aPF4 was positive in most assays performed. Treatment was non-heparin anticoagulants, IV immunoglobulin, and steroids, as recommended by medical guidelines.
Vaccine-induced immune thrombotic thrombocytopenia is a rare complication with high morbidity, related to administration of the AstraZeneca-Oxford vaccine. Clinicians should prepare for early identification of patients with suspicious symptoms, and prompt treatment initiated to avoid catastrophic events. D-dimer determination is useful for surveillance of cases with suspected VITT.
最近描述了接种 ChAdox1 nCoV-19（阿斯利康-牛津）疫苗后发生血小板减少症和血栓形成的情况。这种新病症称为疫苗诱导的免疫性血栓性血小板减少症（VITT）。我们的目的是总结在接种阿斯利康-牛津疫苗的个体中出现/不出现 D-二聚体增加的 VITT 病例报告。
检索 MEDLINE、PubMed 和 Scopus 数据库。
包括病例系列、病例报告、给编辑的信；以及阿斯利康-牛津接种患者的摘要，这些患者具有血小板减少症（血小板计数<150×10 3 /dL）和 D-二聚体测定的临床特征，伴有或不伴有血栓形成、出血和/或血小板因子 4（aPF4）抗体。
检查病例系列报告的 VITT 患者的基线危险因素、症状、体征；实验室结果、影像学发现、治疗；以及预后。
发生 VITT 的患者更有可能是年轻女性（21 至 77 岁），在出现症状前 5 至 14 天接种阿斯利康-牛津疫苗。患者的体征、症状和影像学发现与脑静脉窦血栓形成或深静脉、肺和其他部位一致。实验室发现表现为血小板减少症、低纤维蛋白原和 D-二聚体水平升高，而大多数检测到的 aPF4 呈阳性。根据医学指南，推荐使用非肝素抗凝剂、静脉注射免疫球蛋白和类固醇进行治疗。
疫苗诱导的免疫性血栓性血小板减少症是一种罕见的并发症，发病率高，与阿斯利康-牛津疫苗的使用有关。临床医生应准备好在出现可疑症状时及早识别患者，并启动及时治疗以避免灾难性事件。D-二聚体测定对监测疑似 VITT 病例有用。
