The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.
Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination
Open accessAbstract
BACKGROUND: The mainstay of control of the coronavirus disease 2019 (Covid-19) pandemic is vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a year, several vaccines have been developed and millions of doses delivered. Reporting of adverse events is a critical postmarketing activity. METHODS: We report findings in 23 patients who presented with thrombosis and thrombocytopenia 6 to 24 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca). On the basis of their clinical and laboratory features, we identify a novel underlying mechanism and address the therapeutic implications. RESULTS: In the absence of previous prothrombotic medical conditions, 22 patients presented with acute thrombocytopenia and thrombosis, primarily cerebral venous thrombosis, and 1 patient presented with isolated thrombocytopenia and a hemorrhagic phenotype. All the patients had low or normal fibrinogen levels and elevated d-dimer levels at presentation. No evidence of thrombophilia or causative precipitants was identified. Testing for antibodies to platelet factor 4 (PF4) was positive in 22 patients (with 1 equivocal result) and negative in 1 patient. On the basis of the pathophysiological features observed in these patients, we recommend that treatment with platelet transfusions be avoided because of the risk of progression in thrombotic symptoms and that the administration of a nonheparin anticoagulant agent and intravenous immune globulin be considered for the first occurrence of these symptoms. CONCLUSIONS: Vaccination against SARS-CoV-2 remains critical for control of the Covid-19 pandemic. A pathogenic PF4-dependent syndrome, unrelated to the use of heparin therapy, can occur after the administration of the ChAdOx1 nCoV-19 vaccine. Rapid identification of this rare syndrome is important because of the therapeutic implications.
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Voysey, M., Clemens, S. A. C., Madhi, S. A., Weckx, L. Y., Folegatti, P. M., Aley, P. K., Angus, B., Baillie, V. L., Barnabas, S. L., Bhorat, Q. E., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32661-1 · Cited by 4,616
Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination
Greinacher, A., Thiele, T., Warkentin, T. E., Weisser, K., Kyrle, P. A., & Eichinger, S. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2104840 · Cited by 2,259
Hospitalization and mortality among Black patients and White patients with Covid-19.
Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L. (2020) · New England Journal of Medicine · doi:10.1056/nejmsa2011686 · Cited by 1,660
Grasselli, G., Greco, M., Zanella, A., Albano, G., Antonelli, M., Bellani, G., Bonanomi, E., Cabrini, L., Carlesso, E., Castelli, G., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.3539 · Cited by 1,612
Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination
Schultz, N. H., Sørvoll, I. H., Michelsen, A. E., Munthe, L. A., Lund-Johansen, F., Ahlen, M. T., Wiedmann, M., Aamodt, A.-H., Skattør, T. H., Tjønnfjord, G. E., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2104882 · Cited by 1,452
Hodgson, S. H., Mansatta, K., Mallett, G., Harris, V., Emary, K. R. W., & Pollard, A. J. (2021) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30773-8 · Cited by 633
COVID-19: A review of therapeutic strategies and vaccine candidates
Izda, V., Jeffries, M. A., & Sawalha, A. H. (2021) · Clinical Immunology · doi:10.1016/j.clim.2020.108634 · Cited by 274
Delayed-Onset Heparin-Induced Thrombocytopenia
Rice, L., Attisha, W. K., Drexler, A., & Francis, J. L. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-3-200202050-00009 · Cited by 265
Warkentin, T. E. (2019) · Expert Review of Hematology · doi:10.1080/17474086.2019.1636645 · Cited by 175
A Spontaneous Prothrombotic Disorder Resembling Heparin-induced Thrombocytopenia
Warkentin, T. E., Makris, M., Jay, R. M., & Kelton, J. G. (2008) · The American Journal of Medicine · doi:10.1016/j.amjmed.2008.03.012 · Cited by 170
Cited by
Phase 3 Safety and Efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 Vaccine
Falsey, A. R., Sobieszczyk, M. E., Hirsch, I., Sproule, S., Robb, M. L., Corey, L., Neuzil, K. M., Hahn, W., Hunt, J., Mulligan, M. J., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2105290 · Cited by 670
Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis
Pavord, S., Scully, M., Hunt, B. J., Lester, W., Bagot, C., Craven, B., Rampotas, A., Ambler, G., & Makris, M. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2109908 · Cited by 587
Self-citationPottegård, A., Lund, L. C., Karlstad, Ø., Dahl, J., Andersen, M., Hallas, J., Lidegaard, Ø., Tapia, G., Gulseth, H. L., Ruiz, P. L.-D., et al. (2021) · BMJ · doi:10.1136/bmj.n1114 · Cited by 401
Fibrin drives thromboinflammation and neuropathology in COVID-19
Ryu, J. K., Yan, Z., Montano, M., Sozmen, E. G., Dixit, K., Suryawanshi, R. K., Matsui, Y., Helmy, E., Kaushal, P., Makanani, S. K., et al. (2024) · Nature · doi:10.1038/s41586-024-07873-4 · Cited by 116
Aladdin, Y., Algahtani, H., & Shirah, B. (2021) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2021.105938 · Cited by 48
Metadata
- Authors
- Scully, M., Singh, D., Lown, R., Poles, A., Solomon, T., Levi, M., Goldblatt, D., Kotoucek, P., Thomas, W., & Lester, W.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2021-06-10
- Volume
- 384
- Issue
- 23
- Pages
- 2202-2211
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W3154877986
- Cited by
- 964
- References
- 19
- FWCI
- 188.75
- Type
- journal article
- Language
- en
- Open access
- bronze
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