Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis
Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis
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DOI：
10.1056/nejmoa2109908
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发表时间：
2021-08-11
影响因子：
158.5
通讯作者：
Makris, Mike
中科院分区：
文献类型：
--
作者：
Pavord, Sue;Scully, Marie;Makris, Mike
疫苗诱导的免疫性血小板减少症和血栓形成（VITT）是与抗严重急性呼吸综合征冠状病毒2型的ChAdOx 1 nCoV-19腺病毒载体疫苗相关的一种新的综合征。缺乏关于这种疾病的临床特征和预后标准的数据。方法我们进行了一项前瞻性队列研究，涉及2021年3月22日至6月6日期间在英国医院就诊的疑似VITT患者。使用匿名电子表格收集数据，并根据预先规定的标准将病例确定为明确或可能的VITT。确定患者的基线特征和临床病理特征、危险因素、治疗和预后不良的标志物。结果在294例患者中，我们确定了170例确诊的VITT和50例可能的VITT。所有患者均接受了第一剂ChAdOx 1 nCoV-19疫苗，并在接种后5至48天（中位数，14）就诊。年龄范围为18至79岁（中位数为48岁），没有性别优势，也没有可识别的医学风险因素。总死亡率为22%。死亡几率增加了2.7倍（95%置信区间[CI]，1.4至5.2），在脑静脉窦血栓形成患者中，因子为1.7基线血小板计数每降低50%（95% CI，1.3 - 2.3），因子为1.2基线d-二聚体水平每增加10，000个纤维蛋白原当量单位（95%CI，1.0至1.3），基线纤维蛋白原水平每降低50%，增加1.7倍（95%CI，1.1至2.5）。多变量分析确定基线血小板计数和颅内出血与死亡独立相关;在血小板计数低于30，000/mm 3和颅内出血的患者中，观察到的死亡率为73%。结论血小板计数低和颅内出血的患者中，VITT相关的高死亡率最高。治疗仍然不确定，但预后标志物的识别可能有助于指导有效的管理。（由牛津大学医院NHS基金会信托基金资助。疫苗诱导的血小板减少症和血栓形成在英国的220名患者中定义了VITT的表型，这些患者在首次ChAdOx 1 nCoV-19疫苗接种后的中位数为14天。其中一半患有脑静脉窦血栓形成，三分之一还患有颅内出血。死亡率为22%。静脉注射免疫球蛋白可逆转VITT。
Background Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a new syndrome associated with the ChAdOx1 nCoV-19 adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2. Data are lacking on the clinical features of and the prognostic criteria for this disorder. Methods We conducted a prospective cohort study involving patients with suspected VITT who presented to hospitals in the United Kingdom between March 22 and June 6, 2021. Data were collected with the use of an anonymized electronic form, and cases were identified as definite or probable VITT according to prespecified criteria. Baseline characteristics and clinicopathological features of the patients, risk factors, treatment, and markers of poor prognosis were determined. Results Among 294 patients who were evaluated, we identified 170 definite and 50 probable cases of VITT. All the patients had received the first dose of ChAdOx1 nCoV-19 vaccine and presented 5 to 48 days (median, 14) after vaccination. The age range was 18 to 79 years (median, 48), with no sex preponderance and no identifiable medical risk factors. Overall mortality was 22%. The odds of death increased by a factor of 2.7 (95% confidence interval [CI], 1.4 to 5.2) among patients with cerebral venous sinus thrombosis, by a factor of 1.7 (95% CI, 1.3 to 2.3) for every 50% decrease in the baseline platelet count, by a factor of 1.2 (95% CI, 1.0 to 1.3) for every increase of 10,000 fibrinogen-equivalent units in the baseline d-dimer level, and by a factor of 1.7 (95% CI, 1.1 to 2.5) for every 50% decrease in the baseline fibrinogen level. Multivariate analysis identified the baseline platelet count and the presence of intracranial hemorrhage as being independently associated with death; the observed mortality was 73% among patients with platelet counts below 30,000 per cubic millimeter and intracranial hemorrhage. Conclusions The high mortality associated with VITT was highest among patients with a low platelet count and intracranial hemorrhage. Treatment remains uncertain, but identification of prognostic markers may help guide effective management. (Funded by the Oxford University Hospitals NHS Foundation Trust.)Vaccine-Induced Thrombocytopenia and Thrombosis The phenotypes of VITT were defined in 220 patients in the United Kingdom who presented a median of 14 days after the first ChAdOx1 nCoV-19 vaccination. Half had cerebral venous sinus thrombosis, a third of whom also had intracranial hemorrhage. Mortality was 22%. Intravenous immune globulin may reverse VITT.