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      Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH

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          Abstract

          The COVID-19 pandemic is an ongoing global healthcare crisis. Based on reports of atypically located thromboses following vaccination with the AstraZeneca COVID-19 vaccine, the Society of Thrombosis and Haemostasis Research (GTH) has issued guidance statements on the recognition, diagnosis, and treatment of this rare complication. It shares pathophysiological features with heparin-induced thrombocytopenia (HIT) and is referred to as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).

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          Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review

          W. Joost Wiersinga, Andrew Rhodes, Allen Cheng … (2020)
          The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19.
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            Risk of venous thromboembolism in patients with COVID‐19: A systematic review and meta‐analysis

            Stephan Nopp, Florian Moik, Bernd Jilma … (2020)
            Abstract Background Venous thromboembolism (VTE) is frequently observed in patients with coronavirus disease 2019 (COVID‐19). However, reported VTE‐rates differ substantially. Objectives We aimed at evaluating available data and estimating the prevalence of VTE in COVID‐19 patients. Methods We conducted a systematic literature search (MEDLINE, EMBASE, WHO COVID‐19 database) to identify studies reporting VTE‐rates in COVID‐19 patients. Studies with suspected high risk of bias were excluded from quantitative synthesis. Pooled outcome rates were obtained within a random effects meta‐analysis. Subgroup analyses were performed for different settings (intensive care unit (ICU) vs. non‐ICU hospitalization and screening vs. no screening) and the association of D‐dimer levels and VTE‐risk was explored. Results Eighty‐six studies (33,970 patients) were identified and 66 (28,173 patients, mean age: 62.6 years, 60% men, 20% ICU‐patients) were included in quantitative analysis. The overall VTE‐prevalence estimate was 14.1% (95%CI 11.6‐16.9), 40.3% (95%CI 27.0‐54.3) with ultrasound‐screening and 9.5% (95%CI 7.5‐11.7) without screening. Subgroup analysis revealed high heterogeneity, with a VTE‐prevalence of 7.9% (95%CI 5.1‐11.2) in non‐ICU and 22.7% (95%CI 18.1‐27.6) in ICU patients. Prevalence of pulmonary embolism (PE) in non‐ICU and ICU patients was 3.5% (95%CI 2.2‐5.1) and 13.7% (95%CI 10.0‐17.9). Patients developing VTE had higher D‐dimer levels (weighted mean difference 3.26 µg/ml (95%CI 2.76‐3.77) than non‐VTE patients. Conclusion VTE occurs in 22.7% of patients with COVID‐19 in the ICU, but VTE risk is also increased in non‐ICU hospitalized patients. Patients developing VTE had higher D‐dimer levels. Studies evaluating thromboprophylaxis strategies in patients with COVID‐19 are needed to improve prevention of VTE.
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              High-dose intravenous immunoglobulin for the treatment and prevention of heparin-induced thrombocytopenia: a review

              Theodore Warkentin (2019)
              Introduction: Heparin-induced thrombocytopenia (HIT) is known for its strong association with thrombosis and distinct pathogenesis involving anti-PF4/polyanion antibodies that activate platelets strongly through clustering of platelet FcγIIa receptors. Autoimmune HIT (aHIT) refers to a subgroup of patients whose HIT antibodies have both heparin-dependent and heparin-independent platelet-activating properties. aHIT patients have atypical clinical presentations including delayed-onset HIT, persisting (refractory) HIT, heparin 'flush' HIT, fondaparinux-associated HIT, severe thrombocytopenia (platelet count <20 × 109/L) with overt disseminated intravascular coagulation, and spontaneous HIT syndrome. Areas covered: This article reviews all available literature describing the use of high-dose intravenous immunoglobulin (IVIG) as an adjunct treatment to anticoagulation in HIT patients. IVIG is usually effective in interrupting platelet activation by aHIT antibodies, manifesting as a rapid platelet count increase after starting IVIG (usual dose, 1g/kg × 2 days). Experience to date suggests IVIG de-escalates HIT and likely reduces thrombotic risk. A new case of aHIT successfully treated with IVIG is presented. Use of IVIG to prevent acute HIT with planned heparin reexposure in antibody-positive patients is also discussed. Expert opinion: High-dose IVIG appears to rapidly inhibit HIT antibody-induced platelet activation and has the potential to become an important treatment adjunct for HIT, particularly in patients with aHIT.
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                Author and article information

                Journal
                Title: Hämostaseologie
                Abbreviated Title: Hamostaseologie
                Publisher: Georg Thieme Verlag KG
                ISSN (Print): 0720-9355
                ISSN (Electronic): 2567-5761
                Publication date (Electronic): April 01 2021
                Affiliations
                [1 ]Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
                [2 ]Vivantes Klinikum im Friedrichshain, Klinik für Innere Medizin Angiologie und Hämostaseologie, Berlin, Germany
                [3 ]Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Eppendorf, Hamburg, Germany
                [4 ]Universitäts-Kinderspital Zürich, Hämatologie, Zürich, Switzerland
                [5 ]Universitätsmedizin Mainz, III. Medizinische Klinik/Hämatologie/CTH, Mainz, Germany
                [6 ]Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
                [7 ]Zentrum für Labormedizin, Hämostase- und Hämophilie-Zentrum, Hämatologisches Ambulatorium, St. Gallen, Switzerland
                [8 ]Institut für Transplantationsdiagnostik und Zelltherapie/Hämostaseologie, Hämotherapie und Transfusionsmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
                [9 ]Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
                Article
                DOI: 10.1055/a-1469-7481
                PubMed ID: 33822348
                SO-VID: be7b6b64-74e7-4ef9-bfb3-3aca19d921be
                Copyright © © 2021
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