Thrombosis patterns and clinical outcome of COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A Systematic Review and Meta-Analysis

• Published in: International journal of infectious diseases Vol. 119; pp. 130 - 139
• Main Authors: Kim, Ah Young, Woo, Wongi, Yon, Dong Keon, Lee, Seung Won, Yang, Jae Won, Kim, Ji Hong, Park, Seoyeon, Koyanagi, Ai, Kim, Min Seo, Lee, Sungsoo, Shin, Jae Il, Smith, Lee
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.06.2022; The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases; Elsevier
• Subjects: adverse event; cerebral venous thrombosis; COVID-19 vaccine; splanchnic vein thrombosis; vaccine thrombosis; vaccine-induced immune thrombotic thrombocytopenia; vaccine thrombosis; adverse event; COVID-19 vaccine; splanchnic vein thrombosis; vaccine-induced immune thrombotic thrombocytopenia; cerebral venous thrombosis
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2022.03.034

•The incidence of COVID-19 vaccine-related venous thrombosis was 28 per 100,000 doses•Common sites of thrombosis: cerebral vein (54%), deep vein/pulmonary thromboembolism (36%), splanchnic vein (19%)•Thrombosis after COVID-19 vaccination occurred more in women and in those aged <50•The pooled antiplatelet factor 4 antibody positivity rate was 91%•Without the benefit of non-heparin anticoagulation, the mortality rate was 32% To meta-analyse the clinical manifestations, diagnosis, treatment, and mortality of vaccine-induced immune thrombotic thrombocytopenia (VITT) after adenoviral vector vaccination. Eighteen studies of VITT after ChAdOx1 nCoV-19 or Ad26.COV2.S vaccine administration were reviewed from PubMed, Scopus, Embase, and Web of Science. The meta-analysis estimated the summary effects and between-study heterogeneity regarding the incidence, manifestations, sites of thrombosis, diagnostic findings, and clinical outcomes. The incidence of total venous thrombosis after ChAdOx1 nCoV-19 vaccination was 28 (95% CI 12-52, I2=100%) per 100,000 doses administered. Of 664 patients included in the quantitative analysis (10 studies), the mean age of patients with VITT was 45.6 years (95% CI 43.8-47.4, I2=57%), with a female predominance (70%). Cerebral venous thrombosis (CVT), deep vein thrombosis (DVT)/pulmonary thromboembolism (PE), and splanchnic vein thrombosis occurred in 54%, 36%, and 19% of patients with VITT, respectively. The pooled incidence rate of CVT after ChAdOx1 nCoV-19 vaccination (23 per 100,000 person-years) was higher than that reported in the pre-pandemic general population (0.9 per 100,000 person-years). Intracranial haemorrhage and extracranial thrombosis accompanied 47% and 33% of all patients with CVT, respectively. The antiplatelet factor 4 antibody positivity rate was 91% (95% CI 88-94, I2=0%) and the overall mortality was 32% (95% CI 24-41, I2=69%), and no significant difference was observed between heparin- and non-heparin-based anticoagulation treatments (risk ratio 0.84, 95% CI 0.47-1.50, I2=0%). Patients with VITT after SARS-CoV-2 vaccination most frequently presented with CVT following DVT/PE and splanchnic vein thrombosis, and about one-third of patients had a fatal outcome. This meta-analysis should provide a better understanding of VITT and assist clinicians in identifying VITT early to improve outcomes and optimise management. [Display omitted]