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Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination.
N Engl J Med. 2021 06 03; 384(22):2124-2130.NEJM

Abstract

We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against coronavirus disease 2019 (Covid-19). The patients were health care workers who were 32 to 54 years of age. All the patients had high levels of antibodies to platelet factor 4-polyanion complexes; however, they had had no previous exposure to heparin. Because the five cases occurred in a population of more than 130,000 vaccinated persons, we propose that they represent a rare vaccine-related variant of spontaneous heparin-induced thrombocytopenia that we refer to as vaccine-induced immune thrombotic thrombocytopenia.

Authors+Show Affiliations

From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.From the Departments of Hematology (N.H.S., G.E.T., P.A.H.), Immunology (L.A.M., F.L.-J.), Neurosurgery (M.W.), Neurology (A.-H.A.), and Radiology and Nuclear Medicine (T.H.S.), and the Research Institute of Internal Medicine (N.H.S., A.E.M., P.A.H.), Oslo University Hospital, and the Faculty of Medicine (A.E.M., G.E.T., P.A.H.), the KG Jebsen Center for B Cell Malignancy (L.A.M., G.E.T.), Institute of Clinical Medicine, and the ImmunoLingo Convergence Center (F.L.-J.), University of Oslo, the Department of Hematology, Akershus University Hospital, Lørenskog (N.H.S.), and the Norwegian National Unit for Platelet Immunology, Division of Diagnostics, University Hospital of North Norway, Tromsø (I.H.S., M.T.A.) - all in Norway.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

33835768

Citation

Schultz, Nina H., et al. "Thrombosis and Thrombocytopenia After ChAdOx1 nCoV-19 Vaccination." The New England Journal of Medicine, vol. 384, no. 22, 2021, pp. 2124-2130.
Schultz NH, Sørvoll IH, Michelsen AE, et al. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;384(22):2124-2130.
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., & Holme, P. A. (2021). Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. The New England Journal of Medicine, 384(22), 2124-2130. https://doi.org/10.1056/NEJMoa2104882
Schultz NH, et al. Thrombosis and Thrombocytopenia After ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021 06 3;384(22):2124-2130. PubMed PMID: 33835768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. AU - Schultz,Nina H, AU - Sørvoll,Ingvild H, AU - Michelsen,Annika E, AU - Munthe,Ludvig A, AU - Lund-Johansen,Fridtjof, AU - Ahlen,Maria T, AU - Wiedmann,Markus, AU - Aamodt,Anne-Hege, AU - Skattør,Thor H, AU - Tjønnfjord,Geir E, AU - Holme,Pål A, Y1 - 2021/04/09/ PY - 2021/4/10/pubmed PY - 2021/6/16/medline PY - 2021/4/9/entrez SP - 2124 EP - 2130 JF - The New England journal of medicine JO - N Engl J Med VL - 384 IS - 22 N2 - We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against coronavirus disease 2019 (Covid-19). The patients were health care workers who were 32 to 54 years of age. All the patients had high levels of antibodies to platelet factor 4-polyanion complexes; however, they had had no previous exposure to heparin. Because the five cases occurred in a population of more than 130,000 vaccinated persons, we propose that they represent a rare vaccine-related variant of spontaneous heparin-induced thrombocytopenia that we refer to as vaccine-induced immune thrombotic thrombocytopenia. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/33835768/Thrombosis_and_Thrombocytopenia_after_ChAdOx1_nCoV_19_Vaccination_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa2104882?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -