24 May 2021

Austrian researchers have reported successful treatment in a patient with a rare thrombotic condition associated with COVID-19 vaccination.

Earlier this year, rare cases of blood clotting disorders were reported following vaccination with Oxford/AstraZeneca SARS-CoV-2 vaccine. The condition, which clinicians called 'vaccine-induced prothrombotic immune thrombocytopenia' (VIPIT), is characterised by thrombosis at unusual sites in the body together with a low blood platelet count. VIPIT is probably caused by a defective immune response in which thrombocyte-activating antibodies are produced.

A previous study on samples from patients with VIPIT suggested that high dose intravenous immunoglobulins could be an effective treatment, essentially out-competing the vaccine-induced antibodies which activate platelets.

Now, Dr Paul Knöbl, of MedUni Vienna in Austria, and his colleagues have treated an acute case of VIPIT using this regime of high dose intravenous immunoglobulins and non-heparin anticoagulation.

The case in question was a 62-year-old woman who attended the emergency ward with a rash caused by broken capillaries following vaccination. Tests showed thrombocytopenia, and low fibrinogen levels, with no symptoms of thrombosis. However, high level of D-dimer in the blood, and the presence of heparin-PF4 antibodies, suggested that thrombosis was occurring in her body.

The doctors acted quickly, and the patient responded to treatment. “Upon immediate therapy with non-heparin anticoagulation, high dose intravenous immunoglobulins, and prednisolone, laboratory parameters steadily improved and the patient was discharged from hospital,” the authors write.

“We conclude that early initiation of intravenous immunoglobulin treatment results in a swift response without thrombotic complications.”

The case report was published in the Journal of Thrombosis and Haemostasis. They add that usual heparin preparations must not be used to prevent clotting as they can trigger or aggravate thrombosis. 

Dr Knöbl commented: “In this case we were able to describe, for the first time, the efficacy of a potentially life-saving treatment strategy for vaccine-induced thrombosis. This experience could be of great help in treating other patients with similar conditions.”

 


Source:

Thaler J, Ay C, Gleixner KV, Hauswirth AW, Cacioppo F, Grafeneder J, Quehenberger P, Pabinger I, Knöbl P. (2021) “Successful treatment of vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).” Journal of Thrombosis and Haemostasis, doi: 10.1111/jth.15346

 

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