Haga Yoichi, Ohara Akira, Yakuwa Tsuneyoshi, Yamashita Akari, Udo Midori, Matsuoka Masaki, Ohara Hiroshi, Yasumoto Atsushi, Takahashi Hiroyuki
Department of Pediatrics, Toho University Medical Center Omori Hospital, 6-11-1, Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan.
Department of Clinical Laboratory, Toho University Medical Center Omori Hospital, 6-11-1, Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan.
Hematol Rep. 2024 Jul 29;16(3):504-511. doi: 10.3390/hematolrep16030048.
Thrombosis after severe acute respiratory syndrome coronavirus 2 vaccination is a serious complication in patients with a thrombophilic predisposition. Herein, we present a 17-year-old female who had underlying antiphospholipid syndrome (APS) and developed deep vein thrombosis (DVT) 6 months after her second BNT162b2 vaccine dose. Although she had no family history of thrombosis, she had previously developed DVT at 6 years of age, with thrombus formation in the right common iliac vein and the inferior vena cava, along with concomitant left pulmonary infarction. The patient had received anticoagulant therapy for 6 years after DVT onset, with subsequent treatment cessation for 5 years without recurrence. She received the BNT162b2 vaccine at 17 years of age, 1 week before a routine outpatient visit. Platelet factor 4 elevation was detected 14 days after the first vaccination, persisting for 5 months without thrombotic symptoms. Six months after the second vaccine dose, the DVT recurred and was treated with a direct oral anticoagulant. The vaccine was hypothesized to exacerbate the patient's APS by activating coagulation. Platelet factor 4 levels may indicate coagulation status. When patients predisposed to thrombosis are vaccinated, coagulation status and platelet activation markers should be monitored to prevent DVT development.
严重急性呼吸综合征冠状病毒2疫苗接种后血栓形成是具有血栓形成倾向患者的一种严重并发症。在此，我们报告一名17岁女性，她患有抗磷脂综合征（APS），在接种第二剂BNT162b2疫苗6个月后发生了深静脉血栓形成（DVT）。尽管她没有血栓形成的家族史，但她曾在6岁时发生过DVT，右髂总静脉和下腔静脉有血栓形成，同时伴有左肺梗死。DVT发病后，该患者接受了6年的抗凝治疗，随后停药5年且未复发。她在17岁时，即常规门诊就诊前1周接种了BNT162b2疫苗。首次接种疫苗14天后检测到血小板因子4升高，持续5个月且无血栓形成症状。第二次接种疫苗6个月后，DVT复发，并接受了直接口服抗凝剂治疗。据推测，疫苗通过激活凝血加重了患者的APS。血小板因子4水平可能表明凝血状态。对于有血栓形成倾向的患者进行疫苗接种时，应监测凝血状态和血小板活化标志物，以预防DVT的发生。
