Cari Luigi, Naghavi Alhosseini Mahdieh, Bergamo Alberta, Pacor Sabrina, Pierno Sabata, Sava Gianni, Nocentini Giuseppe
Section of Pharmacology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Department of Life Sciences, University of Trieste, Trieste, Italy.
Front Cardiovasc Med. 2022 Sep 29;9:967926. doi: 10.3389/fcvm.2022.967926. eCollection 2022.
COVID-19, the severe acute respiratory syndrome, is one of the major emergencies that have affected health care systems. Drugs and oxygen are only partially effective in saving lives in patients with severe COVID-19, and the most important protection from death is vaccination. The widespread use of COVID-19 adenovirus-based vaccines has provided evidence for the occurrence of rare venous thrombotic events including cerebral venous thrombosis and splanchnic venous thrombosis in recipients of Vaxzevria and Jcovden vaccines and the review focus on them. One year ago, thromboses in Vaxzevria recipients have been associated with thrombocytopenia in the presence of antibodies to platelet factor 4 and have been called vaccine-induced immune thrombotic thrombocytopenia (VITT). The incidence of VITT is equal to 9-31 events per one million doses of vaccines as evaluated by health agencies worldwide and is higher in female and young vaccine recipients. More recently, by using the European EudraVigilance database, it has been demonstrated that the incidence of thrombosis in recipients of adenovirus-based vaccines is 5-10 fold higher than that of VITT and 7-12 fold higher than observed in the recipients of Comirnaty, an mRNA-based vaccine, suggesting that adenovirus-based vaccines cause not only VITT but also thrombosis without thrombocytopenia (non-VITT thrombosis). The incidence of the vaccine-dependent non-VITT thrombosis is different in the adenovirus-based vaccines and the VITT/non-VITT incidence ratio depends on the severity of thrombosis and is inversely related to the age of the recipients. The possible causes and clinical implications of non-VITT thrombosis in vaccine recipients are discussed.
新冠病毒病，即严重急性呼吸综合征，是影响医疗系统的主要紧急情况之一。药物和氧气在挽救重症新冠病毒病患者生命方面仅部分有效，而预防死亡的最重要措施是接种疫苗。基于腺病毒的新冠疫苗的广泛使用已证实，接种Vaxzevria疫苗和Jcovden疫苗的受种者会发生包括脑静脉血栓形成和内脏静脉血栓形成在内的罕见静脉血栓事件，本文综述将重点关注这些事件。一年前，接种Vaxzevria疫苗的受种者发生的血栓形成与存在血小板因子4抗体时的血小板减少有关，被称为疫苗诱导的免疫性血栓性血小板减少症（VITT）。据全球卫生机构评估，VITT的发病率为每百万剂疫苗9 - 31例，在女性和年轻疫苗受种者中更高。最近，通过使用欧洲药物警戒数据库（EudraVigilance），已证明基于腺病毒的疫苗受种者中血栓形成的发病率比VITT高5 - 10倍，比基于信使核糖核酸（mRNA）的Comirnaty疫苗受种者中观察到的发病率高7 - 12倍，这表明基于腺病毒的疫苗不仅会导致VITT，还会导致无血小板减少的血栓形成（非VITT血栓形成）。基于腺病毒的疫苗中疫苗依赖性非VITT血栓形成的发病率不同，VITT/非VITT发病率比取决于血栓形成的严重程度，且与受种者年龄呈负相关。本文讨论了疫苗受种者中非VITT血栓形成的可能原因及临床意义。
