Maan Raoel, Lauw Mandy N, China Loise, Patch David, Baiges Anna, Garcia-Pagan Juan Carlos, Hernández-Gea Virginia, Hilleret Marie-Noelle, Tjwa Eric T, Kounis Ilias, Bureau Christophe, Giguet Baptiste, Heurgué Alexandra, Ollivier-Hourmand Isabelle, Causse Xavier, Nery Filipe, Eshraghian Ahad, Plessier Aurélie, Darwish Murad Sarwa
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Hepatology. 2024 Nov 1;80(5):1147-1157. doi: 10.1097/HEP.0000000000000787. Epub 2024 Feb 15.
Since the introduction of SARS-CoV-2 vaccines, several cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) have been described, especially cerebral vein thrombosis. We aimed to retrospectively collect all new cases of acute onset first or recurrent splanchnic vein thrombosis (SVT) following a recent SARS-CoV-2 vaccination within the Vascular Liver Disease Group network.
New cases of SVT were identified from April 2021 to April 2022; follow-up was completed on December 31, 2022. Criteria to define VITT were derived from previous studies. Data from a pre-COVID cohort of patients with SVT (N=436) were used for comparison of clinical presentation, etiology, and outcome. Twenty-nine patients were identified with SVT occurring with a median of 11 days (range 2-76) after the first (48%), second (41%), or third (10%) vaccination (ChAdOx1 nCov-19 (n=12) or BNT162b2 (n=14), other (n=3) Only 2 patients(7%) fulfilled criteria for definite VITT. Twenty (69%) had SVT at multiple sites, including 4 (14%) with concomitant extra-abdominal thrombosis. Only 28% had an underlying prothrombotic condition, compared to 52% in the pre-COVID SVT cohort ( p =0.01). Five patients (17%) underwent bowel resection for mesenteric ischemia, compared with 3% in pre-COVID SVT ( p <0.001). Two patients died shortly after diagnosis (7%).
Although definite VITT was rare, in 72% of cases, no other cause for SVT could be identified following SARS-CoV-2 vaccination. These cases were different from patients with nonvaccine-related SVT, with lower incidence of prothrombotic conditions, higher rates of bowel ischemia, and poorer outcome. Although SVT after SARS-CoV-2 vaccination is rare in absolute terms, these data remain relevant considering ongoing revaccination programs.
自新型冠状病毒2（SARS-CoV-2）疫苗引入以来，已有数例疫苗诱导的免疫性血小板减少症和血栓形成（VITT）的病例被报道，尤其是脑静脉血栓形成。我们旨在回顾性收集血管肝脏疾病组网络内近期接种SARS-CoV-2疫苗后急性发作的首例或复发性内脏静脉血栓形成（SVT）的所有新病例。
2021年4月至2022年4月期间确定了SVT新病例；随访于2022年12月31日完成。定义VITT的标准源自先前的研究。来自COVID-19之前的SVT患者队列（N = 436）的数据用于比较临床表现、病因和结局。确定了29例患者发生SVT，首次（48%）、第二次（41%）或第三次（10%）接种疫苗后的中位时间为11天（范围2 - 76天）（ChAdOx1 nCov-19（n = 12）或BNT162b2（n = 14），其他（n = 3））。仅有2例患者（7%）符合确诊VITT的标准。20例（69%）患者存在多处SVT，包括4例（14%）伴有腹外血栓形成。仅有28%的患者有潜在的血栓前状态，而COVID-19之前的SVT队列中这一比例为52%（p = 0.01）。5例患者（17%）因肠系膜缺血接受了肠切除术，而COVID-19之前的SVT患者中这一比例为3%（p < 0.001）。2例患者在诊断后不久死亡（7%）。
尽管确诊的VITT很少见，但在72%的病例中，接种SARS-CoV-2疫苗后无法确定SVT的其他病因。这些病例与非疫苗相关的SVT患者不同，血栓前状态的发生率较低，肠缺血发生率较高，结局较差。尽管从绝对数量来看，SARS-CoV-2疫苗接种后发生SVT很少见，但考虑到正在进行的再次接种计划，这些数据仍然具有相关性。
