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新型冠状病毒肺炎疫苗接种后血栓栓塞事件的最新情况

Update on Thromboembolic Events After Vaccination Against COVID-19.

作者信息

Anastasiou Theocharis, Sanidas Elias, Lytra Thekla, Mimikos Georgios, Gogas Helen, Mantzourani Marina

机构信息

Department of Cardiology, "Laiko" General Hospital, 11527 Athens, Greece.

Third Cardiology Department, Sotiria Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece.

出版信息

Vaccines (Basel). 2025 Aug 5;13(8):833. doi: 10.3390/vaccines13080833.

Abstract

The association between COVID-19 vaccination and thromboembolic events has garnered significant research attention, particularly with the advent of vaccines based on adenoviral vectors, including AstraZeneca's and Johnson & Johnson's vaccines. This review underscores the uncommon occurrence of venous thromboembolism (VTE), arterial thromboembolism (ATE), and vaccine-induced thrombotic thrombocytopenia (VITT) following COVID-19 vaccination. Although these complications are extremely rare compared to the heightened risk of thrombosis from COVID-19 infection, elements like age, biological sex, type of vaccine and underlying health conditions may contribute to their development. In addition, rare renal complications such as acute kidney injury and thrombotic microangiopathy have been documented, broadening the spectrum of potential vaccine-associated thrombotic manifestations. Current guidelines emphasize early detection, individualized risk assessment, and use of anticoagulation therapy to mitigate risks. Despite these events, the overwhelming majority of evidence supports the continued use of COVID-19 vaccines, given their proven efficacy in reducing severe illness and mortality. In addition, recent comparative data confirm that mRNA-based vaccines are associated with a significantly lower risk of serious thrombotic events compared to adenoviral vector platforms. Ongoing research is essential to further refine preventive and therapeutic strategies, particularly for at-risk populations.

摘要

新冠疫苗接种与血栓栓塞事件之间的关联已引起大量研究关注,尤其是随着基于腺病毒载体的疫苗问世,包括阿斯利康和强生公司的疫苗。本综述强调了新冠疫苗接种后静脉血栓栓塞(VTE)、动脉血栓栓塞(ATE)以及疫苗诱导的血栓性血小板减少症(VITT)的罕见发生情况。尽管与新冠感染引发血栓形成的高风险相比,这些并发症极为罕见,但年龄、生物学性别、疫苗类型和基础健康状况等因素可能促使其发生。此外,已记录到诸如急性肾损伤和血栓性微血管病等罕见的肾脏并发症,拓宽了潜在的疫苗相关血栓形成表现的范围。当前指南强调早期检测、个体化风险评估以及使用抗凝治疗来降低风险。尽管出现了这些事件,但鉴于新冠疫苗在降低重症和死亡率方面已证实的有效性,绝大多数证据支持继续使用新冠疫苗。此外,最近的比较数据证实,与腺病毒载体平台相比,基于mRNA的疫苗发生严重血栓事件的风险显著更低。持续的研究对于进一步完善预防和治疗策略至关重要,特别是针对高危人群。

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本文引用的文献

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Risk of venous thromboembolism after COVID-19 vaccination.COVID-19 疫苗接种后的静脉血栓栓塞风险。
J Thromb Haemost. 2022 Jul;20(7):1638-1644. doi: 10.1111/jth.15725. Epub 2022 Apr 20.

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