Valle Ana, Levy Rachel, Tobias Abraham, Friedman Ellen, Hassan Iman
Internal Medicine, Albert Einstein College of Medicine, Bronx, USA.
Hematology/Oncology, Albert Einstein College of Medicine, Bronx, USA.
Cureus. 2023 May 28;15(5):e39609. doi: 10.7759/cureus.39609. eCollection 2023 May.
As the coronavirus disease 2019 (COVID-19) global pandemic continues, multiple vaccines have been developed to decrease infection rate and number of deaths. Vaccine administration is especially important as new COVID-19 variants emerge. While the number of severe thromboembolic events reported after adenovirus-based vaccination has gained attention, there is little information regarding the presentation and management of post-vaccination venous thromboembolism (VTE). Here, we present two cases of VTE after the Janssen vaccine administration. In the first case, a 98-year-old African American female with hypertension developed bilateral lower extremity edema that evolved into unilateral lower extremity edema 20-35 days following the Janssen vaccine administration. She was found to have an extensive unilateral proximal femoral deep vein thrombosis (DVT) 35 days after the vaccination. In the second case, a 64-year-old African American female developed ecchymosis and unilateral edema six days after the Janssen vaccine administration. She was found to have proximal superficial vein thrombosis two days later. In both cases, laboratory data, including platelets and anti-heparin antibodies were within normal limits. Thus, VTE may be an adverse effect of the Janssen vaccine or any adenovirus-based vaccine, but further surveillance and investigation to elucidate this association are necessary. We advise practitioners to have a high index of suspicion for thrombosis after Janssen vaccine administration, regardless of the presence of thrombocytopenia, and avoidance of heparin products until heparin antibody results return.
随着2019冠状病毒病（COVID-19）全球大流行的持续，多种疫苗已被研发出来以降低感染率和死亡人数。随着新型COVID-19变体的出现，疫苗接种尤为重要。虽然基于腺病毒的疫苗接种后报告的严重血栓栓塞事件数量已受到关注，但关于接种疫苗后静脉血栓栓塞（VTE）的表现和管理的信息却很少。在此，我们报告两例接种杨森疫苗后发生VTE的病例。第一例，一名98岁患有高血压的非裔美国女性在接种杨森疫苗后20 - 35天出现双侧下肢水肿，随后发展为单侧下肢水肿。接种疫苗35天后，她被发现患有广泛的单侧近端股深静脉血栓形成（DVT）。第二例，一名64岁的非裔美国女性在接种杨森疫苗六天后出现瘀斑和单侧水肿。两天后，她被发现患有近端浅静脉血栓形成。在这两例中，包括血小板和抗肝素抗体在内的实验室数据均在正常范围内。因此，VTE可能是杨森疫苗或任何基于腺病毒的疫苗的不良反应，但需要进一步监测和调查以阐明这种关联。我们建议从业者在接种杨森疫苗后对血栓形成保持高度怀疑指数，无论是否存在血小板减少症，并且在肝素抗体结果出来之前避免使用肝素产品。
