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

Kim, Ah Young and Woo, Wongi and Yon, Dong Keon and Lee, Seung Won and Yang, Jae Won and Kim, Ji Hong and Park, Seoyeon and Koyanagi, Ai and Kim, Min Seo and Lee, Sungsoo and Shin, Jae Il and Smith, Lee (2022) Thrombosis patterns and clinical outcome of COVID-19 vaccine-induced immune thrombotic thrombocytopenia: A Systematic Review and Meta-Analysis. International Journal of Infectious Diseases, 119. pp. 130-139. ISSN 1201-9712

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Official URL: https://doi.org/10.1016/j.ijid.2022.03.034

Abstract

Objectives- To meta-analyze the clinical manifestations, diagnosis, treatment, and mortality of vaccine-induced immune thrombotic thrombocytopaenia (VITT) after adenoviral vector vaccination. Methods- 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. Results- The incidence of total venous thrombosis after ChAdOx1 nCoV-19 was 28 (95% CI 12-52, I2=100%) per 100,000 doses administered. Of 664 patients in quantitative analysis (10 studies), the mean age of VITT patients 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%, 19% of VITT patients, respectively. The pooled incidence rate of cerebral venous thrombosis after ChAdOx1 nCoV-19 (23 per 100,000 person-years) was higher than the pre-pandemic rate (0.9 per 100,000 person-years). Intracranial haemorrhage and extracranial thrombosis accompanied 47% and 33% of all CVT patients, respectively. The antiplatelet factor 4 (anti-PF4) 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%). Conclusions- VITT patients 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 optimize management.

Item Type: Journal Article
Keywords: vaccine-induced immune thrombotic thrombocytopenia, adverse events, COVID-19 vaccine, vaccine thrombosis, cerebral venous thrombosis, splanchnic vein thrombosis
Faculty: COVID-19 Research Collection
Faculty of Science & Engineering
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 21 Mar 2022 11:07
Last Modified: 13 Jun 2022 14:27
URI: https://arro.anglia.ac.uk/id/eprint/707418

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