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Successful treatment of vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).
J Thromb Haemost. 2021 Apr 20 [Online ahead of print]JT

Abstract

Cases of unusual thrombosis and thrombocytopenia after administration of the ChAdOx1 nCoV-19 vaccine (AstraZeneca) have been reported. The term vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) was coined to reflect this new phenomenon. In vitro experiments with VIPIT patient sera indicated that high-dose intravenous immunoglobulins (IVIG) competitively inhibit the platelet-activating properties of ChAdOx1 nCoV-19 vaccine induced antibodies. Here, we report a case of a 62-year-old woman who had received this vaccine and developed VIPIT. She visited the emergency ward because of petechiae and hematomas. In the laboratory work-up, thrombocytopenia, low fibrinogen, elevated D-dimer, and positivity in the platelet factor 4/heparin-enzyme-immunoassay were present. Signs and symptoms of thrombosis were absent. Upon immediate therapy with non-heparin anticoagulation, high-dose IVIG, and prednisolone, laboratory parameters steadily improved and the patient was discharged from hospital without thrombotic complications. We conclude that early initiation of VIPIT treatment results in a swift response without thrombotic complications.

Authors+Show Affiliations

Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

33877735

Citation

Thaler, Johannes, et al. "Successful Treatment of Vaccine-induced Prothrombotic Immune Thrombocytopenia (VIPIT)." Journal of Thrombosis and Haemostasis : JTH, 2021.
Thaler J, Ay C, Gleixner KV, et al. Successful treatment of vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). J Thromb Haemost. 2021.
Thaler, J., Ay, C., Gleixner, K. V., Hauswirth, A. W., 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 : JTH. https://doi.org/10.1111/jth.15346
Thaler J, et al. Successful Treatment of Vaccine-induced Prothrombotic Immune Thrombocytopenia (VIPIT). J Thromb Haemost. 2021 Apr 20; PubMed PMID: 33877735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful treatment of vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). AU - Thaler,Johannes, AU - Ay,Cihan, AU - Gleixner,Karoline V, AU - Hauswirth,Alexander W, AU - Cacioppo,Filippo, AU - Grafeneder,Jürgen, AU - Quehenberger,Peter, AU - Pabinger,Ingrid, AU - Knöbl,Paul, Y1 - 2021/04/20/ PY - 2021/04/14/received PY - 2021/04/18/accepted PY - 2021/4/21/pubmed PY - 2021/4/21/medline PY - 2021/4/20/entrez KW - COVID-19 KW - ChAdOx1 vaccine KW - VIPIT KW - high-dose intravenous immunoglobulins KW - vaccine-induced prothrombotic immune thrombocytopenia JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost N2 - Cases of unusual thrombosis and thrombocytopenia after administration of the ChAdOx1 nCoV-19 vaccine (AstraZeneca) have been reported. The term vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) was coined to reflect this new phenomenon. In vitro experiments with VIPIT patient sera indicated that high-dose intravenous immunoglobulins (IVIG) competitively inhibit the platelet-activating properties of ChAdOx1 nCoV-19 vaccine induced antibodies. Here, we report a case of a 62-year-old woman who had received this vaccine and developed VIPIT. She visited the emergency ward because of petechiae and hematomas. In the laboratory work-up, thrombocytopenia, low fibrinogen, elevated D-dimer, and positivity in the platelet factor 4/heparin-enzyme-immunoassay were present. Signs and symptoms of thrombosis were absent. Upon immediate therapy with non-heparin anticoagulation, high-dose IVIG, and prednisolone, laboratory parameters steadily improved and the patient was discharged from hospital without thrombotic complications. We conclude that early initiation of VIPIT treatment results in a swift response without thrombotic complications. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/33877735/Successful_treatment_of_vaccine_induced_prothrombotic_immune_thrombocytopenia__VIPIT__ L2 - https://doi.org/10.1111/jth.15346 DB - PRIME DP - Unbound Medicine ER -
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