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Chung YS, Lam CY, Tan PH, Tsang HF, Wong SCC. Comprehensive Review of COVID-19: Epidemiology, Pathogenesis, Advancement in Diagnostic and Detection Techniques, and Post-Pandemic Treatment Strategies. Int J Mol Sci 2024; 25:8155. [PMID: 39125722 PMCID: PMC11312261 DOI: 10.3390/ijms25158155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
At present, COVID-19 remains a public health concern due to the ongoing evolution of SARS-CoV-2 and its prevalence in particular countries. This paper provides an updated overview of the epidemiology and pathogenesis of COVID-19, with a focus on the emergence of SARS-CoV-2 variants and the phenomenon known as 'long COVID'. Meanwhile, diagnostic and detection advances will be mentioned. Though many inventions have been made to combat the COVID-19 pandemic, some outstanding ones include multiplex RT-PCR, which can be used for accurate diagnosis of SARS-CoV-2 infection. ELISA-based antigen tests also appear to be potential diagnostic tools to be available in the future. This paper also discusses current treatments, vaccination strategies, as well as emerging cell-based therapies for SARS-CoV-2 infection. The ongoing evolution of SARS-CoV-2 underscores the necessity for us to continuously update scientific understanding and treatments for it.
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Affiliation(s)
| | | | | | | | - Sze-Chuen Cesar Wong
- Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China; (Y.-S.C.); (C.-Y.L.); (P.-H.T.); (H.-F.T.)
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Bostancıklıoğlu M, İğci M, Ulaşlı M. Nigella sativa, Anthemis hyaline and Citrus sinensis extracts reduce SARS-CoV-2 replication by fluctuating Rho GTPase, PI3K-AKT, and MAPK/ERK pathways in HeLa-CEACAM1a cells. Gene 2024; 911:148366. [PMID: 38485035 DOI: 10.1016/j.gene.2024.148366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
Traditional remedies have long utilized Anthemis hyaline, Nigella sativa, and Citrus sinensis peel extracts as treatments for microbial infections. This study aimed to investigate the influence of Anthemis hyaline, Nigella sativa, and Citrus sinensis extracts on coronavirus replication and apoptosis-related pathways. HeLa-CEACAM1a cells were exposed to mouse hepatitis virus-A59. After viral inoculation, the mRNA levels of 36 genes were quantified using a Fluidigm Dynamic Array nanofluidic chip. IL-8 level and intracellular Ca2+ concentration was measured, and viral titer was assessed by the TCID50/ml assay to detect the extent of infection. Treatment with Nigella sativa extract surged the inflammatory cytokine IL-8 level at both 24 and 48-hour. Changes in gene expression were notable for RHOA, VAV3, ROCK2, CFL1, RASA1, and MPRIP genes following treatment with any of the extracts. The addition of Anthemis hyaline, Nigella sativa, or Citrus sinensis extracts to coronavirus-infected cells reduced viral presence, with Anthemis hyaline extract leading to a virtually undetectable viral load at 6- and 8-hours after infection. While all treatments influenced IL-8 production and viral levels, Anthemis hyaline extract displayed the most pronounced reduction in viral load. Consequently, Anthemis hyaline extract emerges as the most promising agent, harboring potential therapeutic compounds.
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Affiliation(s)
- Mehmet Bostancıklıoğlu
- Department of Physiology, Faculty of Medicine, Gaziantep University, 27310 Gaziantep, Turkey; Institute of Experimental and Clinical Research, Pole of Endocrinology, Diabetes and Nutrition, Université Catholique de Louvain, Brussels, Belgium
| | - Mehri İğci
- Department of Medical Biology, Faculty of Medicine, Gaziantep University, 27310 Gaziantep, Turkey
| | - Mustafa Ulaşlı
- Department of Medical Biology, Faculty of Medicine, Gaziantep University, 27310 Gaziantep, Turkey.
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Furukawa A, Suzuki Y, Nozuki N, Kurosaka N, Kogawa S, Hara S, Ueno S. Case report: A case of unilateral combined central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis following a third dose of COVID-19 vaccination. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1352962. [PMID: 38984132 PMCID: PMC11182238 DOI: 10.3389/fopht.2024.1352962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/29/2024] [Indexed: 07/11/2024]
Abstract
Purpose The aim of this study was to present a case of severe visual loss due to retinal arteriovenous occlusion and papillitis in one eye following vaccination against coronavirus disease (COVID-19). Methods A 45-year-old man undergoing treatment for hypertension had severely reduced visual acuity in the right eye 1 day after receiving a third dose of a COVID-19 vaccine manufactured by Moderna. Clinical examination showed that the best-corrected visual acuity in the right eye was counting fingers. Other findings included circumferential retinal hemorrhage, perimacular ischemic color, severe macular edema, and severe optic disc swelling, indicating the presence of central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis. Based on the possibility of post-vaccination inflammation and/or abnormal immune response, three courses of steroid pulse therapy were administered, and the visual acuity slightly improved to 20/1,000. Results Three months after the onset of symptoms, macular edema disappeared; conversely, retinal thinning of the macula and extensive non-perfusion areas mainly on the nasal side were noted. Conclusion The findings in this case suggest that inflammation and abnormal immune response after receiving a COVID-19 vaccination may lead to combined retinal arteriovenous occlusion and papillitis.
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Affiliation(s)
- Ami Furukawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Narumi Nozuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naruki Kurosaka
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satomi Kogawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Shinji Ueno
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Lee MT, Lee JW, Lee HJ, Lee JM, Choi JC, Gu KM, Jung SY. Interstitial lung disease following COVID-19 vaccination: a disproportionality analysis using the Global Scale Pharmacovigilance Database (VigiBase). BMJ Open Respir Res 2023; 10:e001992. [PMID: 38081769 PMCID: PMC10729117 DOI: 10.1136/bmjresp-2023-001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Despite several case reports, population-based studies on interstitial lung disease (ILD) following COVID-19 vaccination are lacking. Given the unprecedented safety issue of COVID-19 vaccination, it is important to assess the worldwide patterns of ILD following COVID-19 vaccination. This study aimed to investigate the signals of COVID-19 vaccine-associated ILD compared with other vaccinations using disproportionality analysis. METHODS We analysed the VigiBase database during the period between 13 December 2020 and 26 January 2023. We adopted the case/non-case approach to assess the disproportionality signal of ILD for COVID-19 vaccines via 1:10 matching by age and sex. We compared COVID-19 vaccines with all other vaccines as the reference group. RESULTS Among 1 233 969 vaccine-related reports, 679 were reported for ILD. The majority of ILD cases were related to tozinameran (376 reports, 55.4%), Vaxzevria (129 reports, 19.0%) and elasomeran (78 reports, 11.5%). The reporting OR of ILD following COVID-19 vaccination was 0.86 (95% CI 0.64 to 1.15) compared with all other vaccines. CONCLUSION No significant signal of disproportionate reporting of ILD was observed for COVID-19 vaccines compared with all other vaccines. Moreover, when compared with the influenza vaccines that are known to cause ILD, no signal was observed. This study results might help decision-making on the subsequent COVID-19 vaccination strategy of ILD. Further large and prospective studies are required for more conclusive evidence.
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Affiliation(s)
- Min-Taek Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, The Graduate School of Chung-Ang University, Seoul, Korea
| | - Ju Won Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, The Graduate School of Chung-Ang University, Seoul, Korea
| | - Hyeon Ji Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, The Graduate School of Chung-Ang University, Seoul, Korea
| | - Jong-Min Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
- Department of Global Innovative Drugs, The Graduate School of Chung-Ang University, Seoul, Korea
| | - Jae Chol Choi
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kang-Mo Gu
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
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Takizawa T, Ihara K, Uno S, Ohtani S, Watanabe N, Imai N, Nakahara J, Hori S, Garcia-Azorin D, Martelletti P. Metabolic and toxicological considerations regarding CGRP mAbs and CGRP antagonists to treat migraine in COVID-19 patients: a narrative review. Expert Opin Drug Metab Toxicol 2023; 19:951-967. [PMID: 37925645 DOI: 10.1080/17425255.2023.2280221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Migraine pharmacological therapies targeting calcitonin gene-related peptide (CGRP), including monoclonal antibodies and gepants, have shown clinical effect and optimal tolerability. Interactions between treatments of COVID-19 and CGRP-related drugs have not been reviewed. AREAS COVERED An overview of CGRP, a description of the characteristics of each CGRP-related drug and its response predictors, COVID-19 and its treatment, the interactions between CGRP-related drugs and COVID-19 treatment, COVID-19 and vaccination-induced headache, and the neurological consequences of Covid-19. EXPERT OPINION Clinicians should be careful about using gepants for COVID-19 patients, due to the potential drug interactions with drugs metabolized via CYP3A4 cytochrome. In particular, COVID-19 treatment (especially nirmatrelvir packaged with ritonavir, as Paxlovid) should be considered cautiously. It is advisable to stop or adjust the dose (10 mg atogepant when used for episodic migraine) of gepants when using Paxlovid (except for zavegepant). CGRP moncolconal antibodies (CGRP-mAbs) do not have drug - drug interactions, but a few days' interval between a COVID-19 vaccination and the use of CGRP mAbs is recommended to allow the accurate identification of the possible adverse effects, such as injection site reaction. Covid-19- and vaccination-related headache are known to occur. Whether CGRP-related drugs would be of benefit in these circumstances is not yet known.
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Affiliation(s)
- Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Ihara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Imai
- Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - David Garcia-Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paolo Martelletti
- School of Health Sciences, Unitelma Sapienza University of Rome, Rome, Italy
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Faghihi H, Mottaghi-Dastjerdi N, Sharifzadeh M, Rahimi Kakavandi N. ChAdOx1 nCoV-19 Vaccine and Thrombosis with Thrombocytopenia Syndrome among Adults: A Systematic Review. Adv Pharm Bull 2023; 13:723-735. [PMID: 38022808 PMCID: PMC10676559 DOI: 10.34172/apb.2023.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 12/01/2023] Open
Abstract
Several vaccine-induced thrombotic thrombocytopenia syndrome (VITTS) cases have been reported after the ChAdOx1 nCov-19 vaccination. The current study systematically reviewed the reported post-ChAdOx1 nCoV-19 vaccination thrombotic thrombocytopenia cases. Their laboratory and clinical features, as well as the diagnostic and therapeutic measures, were investigated. Online databases were searched until 25 August 2021. Studies reporting post-ChAdOx1 nCov-19 vaccination thrombotic thrombocytopenia syndrome (TTS) were included. Overall, 167 cases (21-77 years old) from 53 publications were included showing a female dominance of 1.75 times. About 85% of the cases exhibited the primary symptoms within the first two weeks post-vaccination. Headache was the most common initial symptom (>44.2%), and hemorrhage/thrombotic problems (22.46%), as well as discoordination/weakness/numbness/ hemiparesis/cyanotic toes (19.6%), were the most prevalent uncommon initial symptoms. Prothrombin time (PT), D-dimers, and C-reactive protein were the most remarkable increased laboratory parameters in 50.6%, 99.1%, and 55.6% of cases, respectively. In comparison, platelet and fibrinogen were the most remarkable decreased laboratory parameters in 92.7% and 50.5% of cases, respectively. Most VITT cases presented with cerebral venous thrombosis/cerebral venous sinus thrombosis, supraventricular tachycardia, transverse sinus/cerebral thrombosis, pulmonary embolism, and cerebral hemorrhage. Anti-PF4 antibody measurement through immunoassays and functional assays were positive in 86.2% and 73% of cases, respectively. About 31% of the cases died. Early diagnosis and proper therapeutic measures are important in ChAdOx1 nCov-19 vaccine-induced VITTS patients. Therefore, experts are recommended to know the corresponding clinical and laboratory features, as well as diagnostic methods. Elucidation of the pathophysiologic mechanism of ChAdOx1 nCov-19 vaccine-induced TTS deserves further investigation.
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Affiliation(s)
- Homa Faghihi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy Iran University of Medical Sciences, Tehran, Iran
| | - Negar Mottaghi-Dastjerdi
- Department of Pharmacognosy and Pharmaceutical Biotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sharifzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Toxicology and Poisoning Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Rahimi Kakavandi
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Sekulovski M, Mileva N, Vasilev GV, Miteva D, Gulinac M, Peshevska-Sekulovska M, Chervenkov L, Batselova H, Vasilev GH, Tomov L, Lazova S, Vassilev D, Velikova T. Blood Coagulation and Thrombotic Disorders following SARS-CoV-2 Infection and COVID-19 Vaccination. Biomedicines 2023; 11:2813. [PMID: 37893186 PMCID: PMC10604891 DOI: 10.3390/biomedicines11102813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
Although abundant data confirm the efficacy and safety profile of the developed vaccines against COVID-19, there are still some concerns regarding vaccination in high-risk populations. This is especially valid for patients susceptible to thrombotic or bleeding events and hesitant people due to the fear of thrombotic incidents following vaccination. This narrative review focuses on various inherited and acquired thrombotic and coagulation disorders and the possible pathophysiologic mechanisms interacting with the coagulation system during immunization in view of the currently available safety data regarding COVID-19 vaccines. Inherited blood coagulation disorders and inherited thrombotic disorders in the light of COVID-19, as well as blood coagulation and thrombotic disorders and bleeding complications following COVID-19 vaccines, along with the possible pathogenesis hypotheses, therapeutic interventions, and imaging for diagnosing are discussed in detail. Lastly, the lack of causality between the bleeding and thrombotic events and COVID-19 vaccines is debated, but still emphasizes the importance of vaccination against COVID-19, outweighing the minimal risk of potential rare adverse events associated with coagulation.
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Affiliation(s)
- Metodija Sekulovski
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Kozyak Str., 1407 Sofia, Bulgaria
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
| | - Niya Mileva
- Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria;
| | - Georgi Vasilev Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Clinic of Endocrinology and Metabolic Disorders, University Multiprofil Hospital Active Treatement “Sv. Georgi”, 4000 Plovdiv, Bulgaria
| | - Dimitrina Miteva
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of Genetics, Faculty of Biology, Sofia University “St. Kliment Ohridski”, 8 Dragan Tzankov Str., 1164 Sofia, Bulgaria
| | - Milena Gulinac
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of General and Clinical Pathology, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria
| | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of Gastroenterology, University Hospital Lozenetz, 1407 Sofia, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
| | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, University Hospital “St George”, 4000 Plovdiv, Bulgaria;
| | - Georgi Hristov Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, 1756 Sofia, Bulgaria
| | - Latchezar Tomov
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria
| | - Snezhina Lazova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
- Pediatric Clinic, University Hospital “N. I. Pirogov”, 21 “General Eduard I. Totleben” Blvd, 1606 Sofia, Bulgaria
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria
| | - Dobrin Vassilev
- Faculty of Public Health and Healthcare, Ruse University Angel Kanchev, 7017 Ruse, Bulgaria;
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (G.V.V.); (D.M.); (M.G.); (M.P.-S.); (G.H.V.); (L.T.); (S.L.); (T.V.)
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Gaddh M, Scott D, Wysokinski WE, McBane RD, Casanegra AI, Baumann Kreuziger L, Houghton DE. Comparison of Venous Thromboembolism Outcomes after COVID-19 and Influenza Vaccinations. TH OPEN 2023; 7:e303-e308. [PMID: 38053618 PMCID: PMC10695705 DOI: 10.1055/a-2183-5269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 12/07/2023] Open
Abstract
Background Published data on the risk of venous thromboembolism (VTE) with coronavirus disease 2019 (COVID-19) vaccines are scarce and inconclusive, leading to an unmet need for further studies. Methods A retrospective, multicentered study of adult patients vaccinated for one of the three approved COVID-19 vaccines in the United States of America and a pre-COVID-19 cohort of patients vaccinated for influenza at two institutions: Mayo Clinic Enterprise sites and the Medical College of Wisconsin, looking at rate of VTE over 90 days. VTE was identified by applying validated natural language processing algorithms to relevant imaging studies. Kaplan-Meier curves were used to evaluate rate of VTE and Cox proportional hazard models for incident VTE after vaccinations. Sensitivity analyses were performed for age, sex, outpatient versus inpatient status, and type of COVID-19 vaccine. Results A total of 911,381 study subjects received COVID-19 vaccine (mean age: 56.8 [standard deviation, SD: 18.3] years, 55.3% females) and 442,612 received influenza vaccine (mean age: 56.5 [SD: 18.3] years, 58.7% females). VTE occurred within 90 days in 1,498 (0.11%) of the total 1,353,993 vaccinations: 882 (0.10%) in the COVID-19 and 616 (0.14%) in the influenza vaccination cohort. After adjusting for confounding variables, there was no difference in VTE event rate after COVID-19 vaccination compared with influenza vaccination (adjusted hazard ratio: 0.95 [95% confidence interval: 0.85-1.05]). No significant difference in VTE rates was observed between the two cohorts on sensitivity analyses. Conclusion In this large cohort of COVID-19-vaccinated patients, risk of VTE at 90 days was low and no different than a pre-COVID-19 cohort of influenza-vaccinated patients.
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Affiliation(s)
- Manila Gaddh
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - David Scott
- Department of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | | | - Robert D. McBane
- Versiti, Blood Research Institute, Milwaukee, Wisconsin, United States
| | - Ana I. Casanegra
- Versiti, Blood Research Institute, Milwaukee, Wisconsin, United States
| | - Lisa Baumann Kreuziger
- Department of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States
| | - Damon E. Houghton
- Versiti, Blood Research Institute, Milwaukee, Wisconsin, United States
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
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9
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Rachman MJ, Kalanjati VP, Rimbun R, Khadijah F. Retinal Vein Occlusion Amongst People Vaccinated by mRNA- and Viral Vector- COVID-19 Vaccines: A Systematic Review. Clin Ophthalmol 2023; 17:2825-2842. [PMID: 37794952 PMCID: PMC10545804 DOI: 10.2147/opth.s426428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Vaccines are highly effective in lowering the mortality due to COVID-19. Although several suspected adverse events or side effects after vaccination including retinal vein occlusion (RVO) have been reported. We conducted a systematic review using PRISMA methods to analyze the occurrence of RVO among people vaccinated by COVID-19 mRNA- vs viral vector- vaccines on 4 databases from 1-1-2021 to 31-12-2022 using specified MeSH terms. All included studies were assessed using JBI critical appraisal tools for eligibility. The final included studies are 31 studies (n=78 cases from 75 patients; 3 of these patients suffered twice). The median age of the patients was 61 years (28 to 96 years old) and most of them were female (52.00%). Thirty-nine patients received the mRNA vaccine (52.00%), while 36 patients received the viral vector vaccine (48.00%) before the event. The RVO diagnoses are based on physical examination confirmed by Fluorescein Angiography (FA), and/or Optical Coherence Tomography (OCT). The median time interval between vaccination and RVO was 6 days in the mRNA vaccine group and 4 days in the viral vector vaccine group. Central retinal vein occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) were tied as the most common diagnosis in the mRNA vaccine group (20.51% and 20.51%), whilst in the viral vector vaccine group CRVO was the most common diagnosis (17.94%). Most of these cases had good outcomes with improved visual impairment in one or both eyes. From this review, we could not ascertain that the RVO occurs due to the type of COVID-19 vaccines because of the detailed data on the dosage and the history of illness of each patient. However, the awareness that the RVO could develop after COVID-19 vaccination must be taken into consideration, even though it is rare.
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Affiliation(s)
- Maria Jessica Rachman
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Faculty of Medicine, Universitas Ciputra, Surabaya, East Java, Indonesia
| | - Viskasari P Kalanjati
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Rimbun Rimbun
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fira Khadijah
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
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10
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Paik H, Kim SK. Female reproduction and abnormal uterine bleeding after COVID-19 vaccination. Clin Exp Reprod Med 2023; 50:69-77. [PMID: 37258099 DOI: 10.5653/cerm.2023.05925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccines have been widely administered throughout the global community to minimize the morbidity and mortality caused by the COVID-19 pandemic. Although generally well-tolerated, these vaccines have generated some unwanted consequences, including thrombosis and menstrual irregularities. The effect of vaccination on female reproductive function has also been questioned. The aim of this review is to give readers a clear understanding of the effects of COVID-19 vaccines on thrombosis, reproductive function, and menstrual irregularities by systemically analyzing the available literature. The available evidence suggests that COVID-19 vaccines have a minimal impact on ovarian reserve. Furthermore, in vitro fertilization outcomes after COVID-19 vaccination remain unimpaired compared to those who did not receive the vaccines. Current evidence supports a certain degree of impact of COVID-19 vaccines on the menstrual cycle, with the most frequent alteration being menstrual irregularity, followed by menorrhagia. These changes are generally well-tolerated and transient, lasting less than 2 months. This review, by providing information with up-to-date references on this issue, may enhance readers' understanding of the impact of COVID-19 vaccines on female reproductive function and the menstrual cycle.
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Affiliation(s)
- Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Divas R, Prabhat R, Rohit R, Sanjay CA, Sushan H, Bijaya R. Covishield vaccination and pulmonary thromboembolism: A coincidence or a causal association? Clin Case Rep 2023; 11:e7468. [PMID: 37305866 PMCID: PMC10248195 DOI: 10.1002/ccr3.7468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
With the eruption of COVID pandemic, many cases of thromboembolic events in association with the COVID infection were reported suggesting the prothrombotic state associated with the infection. After a few years, eventually some of the COVID vaccines came into implementation. With the discovery and implementation of COVID vaccinations, a very few cases have been reported to have developed thromboembolic events, including pulmonary thromboembolism. Different types of vaccines have been associated with different rates of thromboembolic events. Covishield vaccine is rarely associated with thrombotic complications. In the case report below, we present a case summary of a young married female, who presented with shortness of breath a week after the Covishield vaccination and presented to our tertiary care center with further worsening of symptoms during a course of 6 months. On detailed workup, she was diagnosed to have a large pulmonary thrombus affecting the left main pulmonary artery. Other possible etiologies of the hypercoagulable states were ruled out. Though COVID vaccines are known to induce prothrombotic state in the body, we could not be sure if it was the actual cause for the pulmonary thromboembolism or just a coincidence.
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Affiliation(s)
- Rijal Divas
- Department of Critical Care MedicineTribhuvan University Teaching HospitalMaharajgu, KathmanduNepal
| | - Rijal Prabhat
- Department of Internal MedicineAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Raina Rohit
- Department of Internal MedicineAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Chaudhari Ashish Sanjay
- Department of Internal MedicineAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Homagain Sushan
- Department of Critical Care MedicineTribhuvan University Teaching HospitalMaharajgu, KathmanduNepal
| | - Rawol Bijaya
- Department of Critical Care MedicineTribhuvan University Teaching HospitalMaharajgu, KathmanduNepal
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12
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Low Z, Lani R, Tiong V, Poh C, AbuBakar S, Hassandarvish P. COVID-19 Therapeutic Potential of Natural Products. Int J Mol Sci 2023; 24:ijms24119589. [PMID: 37298539 DOI: 10.3390/ijms24119589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Despite the fact that coronavirus disease 2019 (COVID-19) treatment and management are now considerably regulated, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still one of the leading causes of death in 2022. The availability of COVID-19 vaccines, FDA-approved antivirals, and monoclonal antibodies in low-income countries still poses an issue to be addressed. Natural products, particularly traditional Chinese medicines (TCMs) and medicinal plant extracts (or their active component), have challenged the dominance of drug repurposing and synthetic compound libraries in COVID-19 therapeutics. Their abundant resources and excellent antiviral performance make natural products a relatively cheap and readily available alternative for COVID-19 therapeutics. Here, we deliberately review the anti-SARS-CoV-2 mechanisms of the natural products, their potency (pharmacological profiles), and application strategies for COVID-19 intervention. In light of their advantages, this review is intended to acknowledge the potential of natural products as COVID-19 therapeutic candidates.
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Affiliation(s)
- Zhaoxuan Low
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Rafidah Lani
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Vunjia Tiong
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Chitlaa Poh
- Centre for Virus and Vaccine Research, School of Medical and Life Sciences, Sunway University, Petaling Jaya 47500, Malaysia
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Pouya Hassandarvish
- Tropical Infectious Diseases Research & Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur 50603, Malaysia
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13
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Devaux CA, Camoin-Jau L. Molecular Mimicry of the Viral Spike in the SARS-CoV-2 Vaccine Possibly Triggers Transient Dysregulation of ACE2, Leading to Vascular and Coagulation Dysfunction Similar to SARS-CoV-2 Infection. Viruses 2023; 15:v15051045. [PMID: 37243131 DOI: 10.3390/v15051045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
The benefits of SARS-CoV-2 spike mRNA vaccines are well known, including a significant decline in COVID-19 morbidity and a decrease in the mortality rate of SARS-CoV-2 infected persons. However, pharmacovigilance studies have revealed the existence of rare cases of cardiovascular complications after mass vaccination using such formulations. Cases of high blood pressure have also been reported but were rarely documented under perfectly controlled medical supervision. The press release of these warning signals triggered a huge debate over COVID-19 vaccines' safety. Thereby, our attention was quickly focused on issues involving the risk of myocarditis, acute coronary syndrome, hypertension and thrombosis. Rare cases of undesirable post-vaccine pathophysiological phenomena should question us, especially when they occur in young subjects. They are more likely to occur with inappropriate use of mRNA vaccine (e.g., at the time when the immune response is already very active during a low-noise infection in the process of healing), leading to angiotensin II (Ang II) induced inflammation triggering tissue damage. Such harmful effects observed after the COVID-19 vaccine evoke a possible molecular mimicry of the viral spike transiently dysregulating angiotensin converting enzyme 2 (ACE2) function. Although the benefit/risk ratio of SARS-CoV-2 spike mRNA vaccine is very favorable, it seems reasonable to suggest medical surveillance to patients with a history of cardiovascular diseases who receive the COVID-19 vaccine.
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Affiliation(s)
- Christian A Devaux
- Microbes Evolution Phylogeny and Infection (MEPHI) Laboratory, Aix-Marseille University, Institut de Recherche Pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 13005 Marseille, France
- Centre National de la Recherche Scientifique (CNRS-SNC5039), 13000 Marseille, France
| | - Laurence Camoin-Jau
- Microbes Evolution Phylogeny and Infection (MEPHI) Laboratory, Aix-Marseille University, Institut de Recherche Pour le Développement (IRD), Assistance Publique Hôpitaux de Marseille (APHM), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 13005 Marseille, France
- Laboratoire d'Hématologie, Hôpital de La Timone, APHM, Boulevard Jean-Moulin, 13005 Marseille, France
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14
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Xie B, Semaan DB, Sridharan ND, Eslami MH, Go C. Acute limb ischemia secondary to vaccine-induced thrombotic thrombocytopenia. ANNALS OF VASCULAR SURGERY. BRIEF REPORTS AND INNOVATIONS 2023; 3:100153. [PMID: 36776715 PMCID: PMC9912189 DOI: 10.1016/j.avsurg.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Vaccine-associated thrombosis has previously been described in patients presenting with cerebral sinus thrombosis, deep venous thrombosis/pulmonary embolism, or mesenteric venous thrombosis. Only recently has arterial thrombosis gained attention. A new entity known as vaccine-induced thrombotic thrombocytopenia (VITT) has been associated with the coronavirus disease of 2019 (COVID-19) vaccines produced by AstraZeneca and Johnson & Johnson. We describe a case series of three patients who presented with acute limb ischemia with vaccine-associated arterial occlusions, one of whom was diagnosed with VITT.
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Affiliation(s)
- Bowen Xie
- Division of Vascular Surgery, UPMC, Pittsburgh, PA
| | | | | | | | - Catherine Go
- Division of Vascular Surgery, UPMC, Pittsburgh, PA
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15
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Jacobson BF, Schapkaitz E, Takalani A, Rowji P, Louw VJ, Opie J, Bekker LG, Garrett N, Goga A, Reddy T, Yende-Zuma N, Sanne I, Seocharan I, Peter J, Robinson M, Collie S, Khan A, Takuva S, Gray G. Vascular thrombosis after single dose Ad26.COV2.S vaccine in healthcare workers in South Africa: open label, single arm, phase 3B study (Sisonke study). BMJ MEDICINE 2023; 2:e000302. [PMID: 37063238 PMCID: PMC10083528 DOI: 10.1136/bmjmed-2022-000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023]
Abstract
ObjectiveTo assess the rates of vascular thrombotic adverse events in the first 35 days after one dose of the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) in healthcare workers in South Africa and to compare these rates with those observed in the general population.DesignOpen label, single arm, phase 3B study.SettingSisonke study, South Africa, 17 February to 15 June 2021.ParticipantsThe Sisonke cohort of 477 234 healthcare workers, aged ≥18 years, who received one dose of the Ad26.COV2.S vaccine.Main outcome measuresObserved rates of venous arterial thromboembolism and vaccine induced immune thrombocytopenia and thrombosis in individuals who were vaccinated, compared with expected rates, based on age and sex specific background rates from the Clinical Practice Research Datalink GOLD database (database of longitudinal routinely collected electronic health records from UK primary care practices using Vision general practice patient management software).ResultsMost of the study participants were women (74.9%) and median age was 42 years (interquartile range 33-51). Twenty nine (30.6 per 100 000 person years, 95% confidence interval 20.5 to 44.0) vascular thrombotic events occurred at a median of 14 days (7-29) after vaccination. Of these 29 participants, 93.1% were women, median age 46 (37-55) years, and 51.7% had comorbidities. The observed to expected ratios for cerebral venous sinus thrombosis with thrombocytopenia and pulmonary embolism with thrombocytopenia were 10.6 (95% confidence interval 0.3 to 58.8) and 1.2 (0.1 to 6.5), respectively. Because of the small number of adverse events and wide confidence intervals, no conclusions were drawn between these estimates and the expected incidence rates in the population.ConclusionsVaccine induced immune thrombocytopenia and thrombosis after one dose of the Ad26.COV2.S vaccine was found in only a few patients in this South African population of healthcare workers. These findings are reassuring if considered in terms of the beneficial effects of vaccination against covid-19 disease. These data support the continued use of this vaccine, but surveillance is recommended to identify other incidences of venous and arterial thromboembolism and to improve confidence in the data estimates.Trial registrationClinicalTrials.govNCT04838795.
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Affiliation(s)
- Barry Frank Jacobson
- Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise Schapkaitz
- Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azwi Takalani
- Hutchinson Centre Research Institute of South Africa (HCRISA), Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Pradeep Rowji
- The Southern African Society of Thrombosis and Haemostasis, Neurology Association of South Africa, Johannesburg, South Africa
| | - Vernon Johan Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jessica Opie
- Division of Haematology, Department of Pathology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Nelson R Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, University of the Witwatersrand Faculty of Sciences, Johannesburg, South Africa
| | - Ishen Seocharan
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | | | | | - Amber Khan
- Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simbarashe Takuva
- School of Health Systems and Public Health, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
- Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Glenda Gray
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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16
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Karakaş Ö, Erden A, Armağan B, Güven SC, Atalar E, Polat B, Omma A, Küçükşahin O. Evaluation of patients with antiphospholipid syndrome subsequently COVID-19 vaccinations: A retrospective cohort study. Int J Rheum Dis 2023; 26:292-297. [PMID: 36371485 PMCID: PMC9877926 DOI: 10.1111/1756-185x.14490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
The aim of this study is to evaluate development of side effects, thrombotic or obstetric complications in our antiphospholipid syndrome (APS) patient group, after vaccination against coronavirus disease 2019 (COVID-19). A cohort was formed from patients who have previously been followed up with a diagnosis of APS. The patients of the cohort were evaluated retrospectively to find out if they were vaccinated with CoronaVac and/or BNT162b2 vaccines which are being used in our country. To evaluate the side effects seen after the vaccination, the information was collected by the patients in their outpatient appointments or making a phone call. Thirty-five APS patients who had received at least 1 dose of any of the COVID-19 vaccines were included in the study. Median (min-max) number of vaccine doses per patient was 2 (1-3). Eleven patients had a booster dose after primary vaccination. Twenty patients were ever vaccinated with BNT162b2 and 18 with CoronaVac. Among BNT162b2 recipients, 9 (45.0%) and among CoronaVac recipients 15 (42.9%) reported an adverse event after a vaccine administration. The most common adverse events were myalgia and malaise after any dose of both vaccines. No vaccine-related new thrombotic events or APS flares were observed. Our results were comparable with those reported in the literature. Comprehensive large-scale studies are needed for more accurate results on the evaluation of side effects after COVID-19 vaccination in APS patients.
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Affiliation(s)
- Özlem Karakaş
- Clinic of RheumatologyAnkara City HospitalAnkaraTurkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal MedicineAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
| | | | | | - Ebru Atalar
- Clinic of RheumatologyAnkara City HospitalAnkaraTurkey
| | | | - Ahmet Omma
- Clinic of RheumatologyHealth Sciences University, Ministry of Health Ankara City HospitalAnkaraTurkey
| | - Orhan Küçükşahin
- Division of Rheumatology, Department of Internal MedicineAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
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17
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Hematological Questions in Personalized Management of COVID-19 Vaccination. J Pers Med 2023; 13:jpm13020259. [PMID: 36836493 PMCID: PMC9965747 DOI: 10.3390/jpm13020259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been causing a worldwide pandemic since 2019. Many vaccines have been manufactured and have shown promising results in reducing disease morbidity and mortality. However, a variety of vaccine-related adverse effects, including hematological events, have been reported, such as thromboembolic events, thrombocytopenia, and bleeding. Moreover, a new syndrome, vaccine-induced immune thrombotic thrombocytopenia, following vaccination against COVID-19 has been recognized. These hematologic side effects have also raised concerns about SARS-CoV-2 vaccination in patients with preexisting hematologic conditions. Patients with hematological tumors are at a higher risk of severe SARS-CoV-2 infection, and the efficacy and safety of vaccination in this group remain uncertain and have raised attention. In this review, we discuss the hematological events following COVID-19 vaccination and vaccination in patients with hematological disorders.
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18
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Ruiz-Núñez C, Herrera-Peco I, Campos-Soler SM, Carmona-Pestaña Á, Benítez de Gracia E, Peña Deudero JJ, García-Notario AI. Sentiment Analysis on Twitter: Role of Healthcare Professionals in the Global Conversation during the AstraZeneca Vaccine Suspension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2225. [PMID: 36767591 PMCID: PMC9915361 DOI: 10.3390/ijerph20032225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The vaccines against COVID-19 arrived in Spain at the end of 2020 along with vaccination campaigns which were not free of controversy. The debate was fueled by the adverse effects following the administration of the AstraZeneca-Oxford (AZ) vaccine in some European countries, eventually leading to its temporary suspension as a precautionary measure. In the present study, we analyze the healthcare professionals' conversations, sentiment, polarity, and intensity on social media during two periods in 2021: the one closest to the suspension of the AZ vaccine and the same time frame 30 days later. We also analyzed whether there were differences between Spain and the rest of the world. Results: The negative sentiment ratio was higher (U = 87; p = 0.048) in Spain in March (Med = 0.396), as well as the daily intensity (U = 86; p = 0.044; Med = 0.440). The opposite happened with polarity (U = 86; p = 0.044), which was higher in the rest of the world (Med = -0.264). Conclusions: There was a general increase in messages and interactions between March and April. In Spain, there was a higher incidence of negative messages and intensity compared to the rest of the world during the March period that disappeared in April. Finally, it was found that the dissemination of messages linked to negative emotions towards vaccines against COVID-19 from healthcare professionals contributed to a negative approach to primary prevention campaigns in the middle of the pandemic.
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Affiliation(s)
- Carlos Ruiz-Núñez
- Program in Biomedicine, Translational Research, and New Health Technologies, School of Medicine, University of Malaga, Blvr. Louis Pasteur, 29010 Malaga, Spain
| | - Ivan Herrera-Peco
- Faculty of Health Sciences, Universidad Alfonso X el Sabio, Avda Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Silvia María Campos-Soler
- Faculty of Medicine, Universidad Alfonso X el Sabio, Avda Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Álvaro Carmona-Pestaña
- Faculty of Medicine, Universidad Alfonso X el Sabio, Avda Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Elvira Benítez de Gracia
- Faculty of Health Sciences, Universidad Alfonso X el Sabio, Avda Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Juan José Peña Deudero
- Faculty of Health Sciences, Universidad Alfonso X el Sabio, Avda Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Andrés Ignacio García-Notario
- Faculty of Medicine, Universidad Alfonso X el Sabio, Avda Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
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19
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Deep vein thrombosis during vaccination against SARS-CoV-2 period. ANGIOLOGIA 2023. [DOI: 10.20960/angiologia.00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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20
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Pons S, Uhel F, Frapy E, Sérémé Y, Zafrani L, Aschard H, Skurnik D. How Protective are Antibodies to SARS-CoV-2, the Main Weapon of the B-Cell Response? Stem Cell Rev Rep 2022; 19:585-600. [PMID: 36422774 PMCID: PMC9685122 DOI: 10.1007/s12015-022-10477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
Since the beginning of the Coronavirus disease (COVID)-19 pandemic in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for more than 600 million infections and 6.5 million deaths worldwide. Given the persistence of SARS-CoV-2 and its ability to develop new variants, the implementation of an effective and long-term herd immunity appears to be crucial to overcome the pandemic. While a vast field of research has focused on the role of humoral immunity against SARS-CoV-2, a growing body of evidence suggest that antibodies alone only confer a partial protection against infection of reinfection which could be of high importance regarding the strategic development goals (SDG) of the United Nations (UN) and in particular UN SDG3 that aims towards the realization of good health and well being on a global scale in the context of the COVID-19 pandemic.In this review, we highlight the role of humoral immunity in the host defense against SARS-CoV-2, with a focus on highly neutralizing antibodies. We summarize the results of the main clinical trials leading to an overall disappointing efficacy of convalescent plasma therapy, variable results of monoclonal neutralizing antibodies in patients with COVID-19 but outstanding results for the mRNA based vaccines against SARS-CoV-2. Finally, we advocate that beyond antibody responses, the development of a robust cellular immunity against SARS-CoV-2 after infection or vaccination is of utmost importance for promoting immune memory and limiting disease severity, especially in case of (re)-infection by variant viruses.
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Affiliation(s)
- Stéphanie Pons
- DMU DREAM, Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière, Paris, France
- Université de Paris Cité, INSERM U976- Human Immunology, Pathophysiology, Immunotherapy (HIPI), Paris, France
| | - Fabrice Uhel
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France
- DMU ESPRIT, Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, 92700, Colombes, France
| | - Eric Frapy
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France
| | - Youssouf Sérémé
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France
| | - Lara Zafrani
- Université de Paris Cité, INSERM U976- Human Immunology, Pathophysiology, Immunotherapy (HIPI), Paris, France
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Hugues Aschard
- Department of Computational Biology, USR 3756 CNRS, Institut Pasteur, Paris, France
| | - David Skurnik
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France.
- Department of Clinical Microbiology, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris Cité, Paris, France.
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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21
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Nicholson M, Goubran H, Chan N, Siegal D. No apparent association between mRNA COVID-19 vaccination and venous thromboembolism. Blood Rev 2022; 56:100970. [PMID: 35577626 PMCID: PMC9091073 DOI: 10.1016/j.blre.2022.100970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 12/12/2022]
Abstract
By January 2022 over ten billion doses of COVID-19 vaccines had been administered worldwide. Concerns about COVID-19 vaccine-associated thrombosis arose after the characterization of a rare prothrombotic condition associated with adenoviral vector-based COVID-19 vaccines known as vaccine-induced immune thrombotic thrombocytopenia (VITT). Although mRNA COVID-19 vaccines have not been linked to VITT, concerns about thrombosis after vaccination persist despite safety data from hundreds of millions of recipients of mRNA COVID-19 vaccines. With widespread vaccination some VTE will occur shortly after vaccination by chance alone because VTE is a common condition that affects 1 to 2 in 1000 persons each year. Detailed analysis is required to determine whether these VTE events are coincidental or associated when they occur in close proximity to mRNA vaccine administration. This paper will review what is currently known about rates of VTE after mRNA vaccination in adults, discuss the reasons why uncertainty on this topic persists, and briefly review the implications of these findings for clinical practice and health policy.
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Affiliation(s)
- Matthew Nicholson
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, and College of Medicine, University of Saskatchewan, SK, Canada.
| | - Hadi Goubran
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, and College of Medicine, University of Saskatchewan, SK, Canada
| | - Noel Chan
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Deborah Siegal
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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22
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Tan LJ, Koh CP, Lai SK, Poh WC, Othman MS, Hussin H. A systemic review and recommendation for an autopsy approach to death followed the COVID 19 vaccination. Forensic Sci Int 2022; 340:111469. [PMID: 36162300 PMCID: PMC9487151 DOI: 10.1016/j.forsciint.2022.111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/28/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019. An immediate prevention approach for the outbreak is the development of a vaccination program. Despite a growing number of publications showing the effectiveness of vaccination in preventing SARS-CoV-2 outbreak and reducing the mortality rate, substantial fatal adverse effects were reported after vaccination. Confirmation of the causal relationship of death is required to reimburse under the national vaccination program and could provide a reference for the selection of vaccination. However, a lack of guidelines in the laboratory study and autopsy approach hampered the investigation of post-vaccination death. In this paper, we performed a systematic electronic search on scientific articles related to severe Covid-19 vaccination adverse effects and approaches in identifying the severe side effects using PubMed and Cochrane libraries. A summary on the onset, biochemistry changes and histopathological analyzes of major lethally side effects post-vaccination were discussed. Ultimately, a checklist is suggested to improve the quality of investigation.
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Affiliation(s)
- Lii Jye Tan
- Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia.
| | - Cai Ping Koh
- Department of Biochemistry, Faculty of Medicine, Quest International University, Malaysia
| | - Shau Kong Lai
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Woon Cheng Poh
- Department of Biochemistry, Faculty of Medicine, Quest International University, Malaysia
| | - Mohammad Shafie Othman
- Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia
| | - Huzlinda Hussin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
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23
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Stefanou MI, Palaiodimou L, Aguiar de Sousa D, Theodorou A, Bakola E, Katsaros DE, Halvatsiotis P, Tzavellas E, Naska A, Coutinho JM, Sandset EC, Giamarellos-Bourboulis EJ, Tsivgoulis G. Acute Arterial Ischemic Stroke Following COVID-19 Vaccination: A Systematic Review and Meta-analysis. Neurology 2022; 99:e1465-e1474. [PMID: 36002319 DOI: 10.1212/wnl.0000000000200996] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute arterial ischemic stroke (AIS) has been reported as a rare adverse event following coronavirus disease 2019 (COVID-19) vaccination with messenger RNA (mRNA) or viral vector vaccines. However, data are sparse regarding the risk of postvaccination AIS and its potential association with thrombotic-thrombocytopenia syndrome (TTS). METHODS A systematic review and meta-analysis of randomized controlled clinical trials (RCTs), pharmacovigilance registries, registry-based studies, observational cohorts, and case-series was performed with the aim to calculate the following: (1) the pooled proportion of patients presenting with AIS following COVID-19 vaccination; (2) the prevalence of AIS after mRNA and vector-based vaccination; and (3) the proportion of TTS among postvaccination AIS cases. Patient characteristics were assessed as secondary outcomes. RESULTS Two RCTs, 3 cohort studies, and 11 registry-based studies comprising 17,481 AIS cases among 782,989,363 COVID-19 vaccinations were included in the meta-analysis. The pooled proportion of AIS following exposure to any COVID-19 vaccine type was 4.7 cases per 100,000 vaccinations (95% CI 2.2-8.1; I 2 = 99.9%). The pooled proportion of AIS following mRNA vaccination (9.2 cases per 100,000 vaccinations; 95% CI 2.5-19.3; I 2 = 99.9%) did not differ compared with adenovirus-based vaccination (2.9 cases per 100,000 vaccinations; 95% CI 0.3-7.8; I 2 = 99.9%). No differences regarding demographics were disclosed between patients with AIS following mRNA-based or vector-based vaccination. The pooled proportion of TTS among postvaccination AIS cases was 3.1% (95% CI 0.7%-7.2%; I 2 = 78.8%). DISCUSSION The pooled proportion of AIS following COVID-19 vaccination is comparable with the prevalence of AIS in the general population and much lower than the AIS prevalence among severe acute respiratory syndrome coronavirus 2-infected patients. TTS is very uncommonly reported in patients with AIS following COVID-19 vaccination.
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Affiliation(s)
- Maria-Ioanna Stefanou
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Lina Palaiodimou
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Diana Aguiar de Sousa
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Aikaterini Theodorou
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Eleni Bakola
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Dimitrios Eleftherios Katsaros
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Panagiotis Halvatsiotis
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Elias Tzavellas
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Androniki Naska
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Jonathan M Coutinho
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Else Charlotte Sandset
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Evangelos J Giamarellos-Bourboulis
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Georgios Tsivgoulis
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis.
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24
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Simpkins AN, Cheng S. COVID-19 Exposures, Vaccines, and Acute Ischemic Stroke Risk: On Balance and in Balance. Neurology 2022; 99:597-598. [PMID: 36002318 DOI: 10.1212/wnl.0000000000201109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexis N Simpkins
- From the Department of Neurology (A.N.S.), Cedars-Sinai Medical Center; and Department of Cardiology (S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Susan Cheng
- From the Department of Neurology (A.N.S.), Cedars-Sinai Medical Center; and Department of Cardiology (S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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25
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Thakar M, Bhattacharya S. Central retinal artery occlusion after vaccination with whole virion inactivated SARSCoV- 2 vaccine Covaxin. Indian J Ophthalmol 2022; 70:3716-3718. [PMID: 36190081 PMCID: PMC9789834 DOI: 10.4103/ijo.ijo_1148_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccinations have been associated with a higher risk of thromboembolic events. There have been no reports of central retinal artery occlusion (CRAO) after vaccination with the indigenously developed Covaxin, and worldwide, there has been only one such isolated case after administration of the AstraZeneca vaccine. We report a case of a 44-year-old healthy man who presented with sudden painless vision loss in his left eye 10 days after receiving Covaxin. His best-corrected visual acuity was minimal perception of light, with a relative afferent pupillary defect. Fundus examination revealed arterial attenuation and macular cherry red spot, suggesting an acute CRAO. Optical coherence tomography showed macular swelling and disorganization of the inner layers due to ischemic sequelae. Blood work was normal and cardiovascular examination was unremarkable. The patient was kept on follow-up. To our knowledge, this is the first case of an isolated CRAO after Covaxin administration, but further studies are needed to evaluate this potential association.
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Affiliation(s)
- Meenakshi Thakar
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Shruti Bhattacharya
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, Delhi, India,Correspondence to: Dr. Shruti Bhattacharya, Retina Clinic, Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi - 110002, India. E-mail:
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26
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Chen YC. Combined central retinal artery occlusion and vein occlusion with exudative retinal detachment following COVID-19 vaccination. Kaohsiung J Med Sci 2022; 38:1020-1021. [PMID: 36098473 PMCID: PMC9538132 DOI: 10.1002/kjm2.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/17/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yen-Chih Chen
- Department of Ophthalmology, Yunlin Christian Hospital, Xiluo, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
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27
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Mirghaderi SP, Salimi M, Moharrami A, Hosseini-Dolama R, Mirghaderi SR, Ghaderi M, Motififard M, Mortazavi SMJ. COVID-19 Infection Risk Following Elective Arthroplasty and Surgical Complications in COVID-19 Vaccinated Patients: A Multicenter Comparative Cohort Study. Arthroplast Today 2022; 18:76-83. [PMID: 36185411 PMCID: PMC9513341 DOI: 10.1016/j.artd.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background We aimed to determine symptomatic Coronavirus disease 2019 (COVID-19) rates within 1 month of elective arthroplasty for vaccinated individuals and to determine whether vaccination guarantees protection against COVID-19 after arthroplasty (primary outcome). In addition, the 90-day surgical complications were compared to those of an unvaccinated group (secondary outcome). Methods A prospective cohort study was conducted on elective joint arthroplasty patients at 3 tertiary hospitals in 2 major cities (Tehran and Isfahan) in our country (Iran). The outcomes of the COVID-19-vaccinated group were assessed between October 2021 and March 2022. Ninety-day surgical complications were compared with a historical cohort of unvaccinated patients treated earlier in the pandemic (April 2020-March 2021). Results The study included 1717 consecutive patients: 962 vaccinated and 755 unvaccinated. In the vaccinated group, 38 patients (3.9%) contracted COVID-19, 4 (10.5%) were hospitalized again, and none required intensive care unit admission. The multivariate logistic regression analysis revealed that COVID-19-positive cases are more likely to be female (odds ratio [OR] = 12.5), to have visitors to their home (OR = 4.7), and to stay longer in the hospital (OR = 1.2) than COVID-19-negative cases. Compared to unvaccinated patients, the postoperative COVID-19 rate was not significantly different (3.9% vs 2.4%, P = .07). The incidence of surgical complications was similar between the 2 groups (P > .05). Conclusions The vaccination does not provide a guarantee that a patient will not contract COVID-19 following their arthroplasty surgery, especially in a region with a high rate of COVID-19. We believe reasonable perioperative COVID-19 precautions may be warranted even in vaccinated patients.
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Affiliation(s)
- Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Salimi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hosseini-Dolama
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Ghaderi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Motififard
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author. Joint Reconstruction Research Center, Imam Khomeini Hospital, End of Keshavarz Blvd 1419733141, Tehran, Iran. Tel.: +982166581586.
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28
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Khan Z, Besis G, Candilio L. COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia With Venous and Arterial Thrombosis: A Case Report. Cureus 2022; 14:e28535. [PMID: 36185940 PMCID: PMC9518638 DOI: 10.7759/cureus.28535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Coronavirus disease 19 pandemic has put tremendous pressure on health systems and has caused significant morbidity and mortality throughout the world. Vaccination program against COVID-19 has been effective despite repeated outbreaks across the globe. It was however reported that COVID-19 vaccines in particular, the Oxford-AstraZeneca COVID-19 vaccine (AZD1222) was temporarily suspended by some European countries due to risk of thrombosis. COVID-19 is a prothrombotic condition and is associated with venous thromboembolism mainly. The condition can be challenging to diagnose due to its diagnostic variation. Cases of vaccine-induced thrombotic thrombocytopaenia has been reported in several countries. COVID-19 can also cause vaccine-induced thrombosis without thrombocytopaenia. The thrombotic events can affect different parts of the body including brain, heart, and peripheral vessels. We present a case of 54-year-old patient who presented with chest and abdominal pain for 12 hours and evidence of infero-lateral ST segment elevation on electrocardiogram. Patient received COVID-19 AstraZeneca vaccine 10 days prior to admission. Coronary angiography (CAG) showed occlusion of the proximal to mid part of the right coronary artery (RCA) distal to a large Right Ventricular branch with high thrombotic burden and multiple attempts at aspiration of the thrombus resulted in partial restoration of the flow to right coronary artery.
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29
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Laffan MA, Rees S, Yadavalli M, Ferstenberg LB, Kumar Shankar N, Medin J, Foskett N, Arnold M, Gomes da Silva H, Bhuyan P, Nord M. Thrombosis with thrombocytopenia after AZD1222 (ChAdOx1 nCov-19) vaccination: Case characteristics and associations. Vaccine 2022; 40:5585-5593. [PMID: 35989136 PMCID: PMC9388294 DOI: 10.1016/j.vaccine.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/20/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
Background Post-marketing surveillance for COVID-19 vaccines during the pandemic identified an extremely rare thrombosis with thrombocytopenia syndrome (TTS) reported post-vaccination, requiring further characterisation to improve diagnosis and management. Methods We searched the AstraZeneca Global Safety Database (through April 26, 2021) for cases with co-reported thrombocytopenia and thrombosis (using standardised MedDRA queries/high-level terms) following AZD1222 (ChAdOx1 nCoV-19). Cases were adjudicated by experts as ‘typical’,’possible’, ‘no’ or ‘unknown’ according to available TTS criteria. Additional confirmatory datasets (May 20–June 20, October 1–December 28) were evaluated. Findings We identified 573 reports, including 273 (47.6 %) ‘typical’ and 171 (29.8 %) ’possible’ TTS cases. Of these 444 cases, 275 (61.9 %) were female, median age was 50.0 years (IQR: 38.0–60.0). Cerebral venous sinus thrombosis was reported in 196 (44.1 %) cases, splanchnic venous thrombosis in 65 (14.6 %) and thromboses at multiple sites in 119 (26.8 %). Median time to onset was 12.0 days (IQR: 9.0–15.0). Comparison with a pre-pandemic reference population indicated higher rates of autoimmune disorders (13.8 %, 4.4 %), previous heparin therapy (7.4 %, 1.2 %), history of thrombosis (5.5 %, 1.4 %), and immune thrombocytopenia (6.1 %, 0.2 %). Fatality rate was 22.2 % (127/573) overall and 23.6 % (105/444) in ‘typical’/’possible’ TTS, which decreased from 39.0 % (60/154) in February/March to 15.5 % (45/290) in April. Overall patterns were similar in confirmatory datasets. Conclusions The reporting rate of ‘typical’/’possible’ TTS post first-dose vaccination in this dataset is 7.5 per million vaccinated persons; few cases were reported after subsequent doses, including booster doses. Peak reporting coincided with media-driven attention. Medical history differences versus a reference population indicate potentially unidentified risk factors. The decreasing fatality rate correlates with increasing awareness and publication of diagnostic/treatment guidelines. Adjudication was hindered by unreported parameters, and an algorithm was developed to classify potential TTS cases; comprehensive reporting could help further improve definition and management of this extremely rare syndrome.
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Affiliation(s)
- Michael A Laffan
- Faculty of Medicine, Department of Immunology and Inflammation, Imperial College London, Room 5S5b, The Hammersmith Hospital, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
| | - Sue Rees
- Sue Rees Consultancy Ltd, Verulam Point, Station Way, St. Albans AL1 5HE, UK.
| | - Madhavi Yadavalli
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, 1 Medimmune Way, Gaithersburg, MD 20878, USA.
| | - Lisa Beth Ferstenberg
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, 1 Medimmune Way, Gaithersburg, MD 20878, USA.
| | - Nirmal Kumar Shankar
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, India Pvt. Ltd, Rachenahalli, Outer Ring Road, Bangalore 560045, India.
| | - Jennie Medin
- BioPharmaceuticals Medical, AstraZeneca, Pepparedsleden 1, Mölndal SE431 83, Gothenburg, Sweden.
| | - Nadia Foskett
- BioPharmaceuticals Medical, AstraZeneca, Academy House 136 Hills Road, Cambridge CB2 8PA, UK.
| | - Matthew Arnold
- BioPharmaceuticals Medical, AstraZeneca, Granta Park, Cambridge CB21 6GP, UK.
| | - Hugo Gomes da Silva
- Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Rua Humberto Madeira 7 / 7A, 2730-097 Lisboa, Portugal.
| | - Prakash Bhuyan
- Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, 1 Medimmune Way, Gaithersburg, MD 20878, USA.
| | - Magnus Nord
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, Pepparedsleden 1, Mölndal SE431 83, Gothenburg, Sweden.
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Lai D, Zhang YD, Lu J. Venous Thromboembolism following Two Doses of COVID-19 mRNA Vaccines in the US Population, 2020–2022. Vaccines (Basel) 2022; 10:vaccines10081317. [PMID: 36016205 PMCID: PMC9414190 DOI: 10.3390/vaccines10081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 mRNA vaccine is one of the most effective strategies used to fight against COVID-19. Recently, venous thromboembolism (VTE) events after COVID-19 mRNA vaccination have been reported in various research. Such a concern may hamper the ongoing COVID-19 vaccination campaign. Based on the US Vaccine Adverse Event Reporting System data, this modified self-controlled case series study investigated the association of COVID-19 mRNA vaccination with VTE events among US adults. We found the VTE incidence rate in the recommended dose interval does not change significantly after receiving COVID-19 mRNA vaccines. This conclusion still holds if the analysis is stratified by age and gender. The VTE onset may not be significantly associated with COVID-19 mRNA vaccination.
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Affiliation(s)
- Daoyuan Lai
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong 999077, China
| | - Yan Dora Zhang
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong 999077, China
- Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Junfeng Lu
- First Department of Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing 100069, China
- Correspondence:
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31
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Aran S, Kayder OO, Chopra T, Abujudeh H. Superficial thrombophlebitis in ipsilateral breast after COVID-19 vaccination. Radiol Case Rep 2022; 17:2883-2887. [PMID: 35711742 PMCID: PMC9189435 DOI: 10.1016/j.radcr.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
On December 2020, the US Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report development of superficial thrombophlebitis in the ipsilateral breast of a 43-year-old female 7 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. Given that this is the first case of superficial thrombophlebitis in the breast shortly after mRNA vaccination for COVID-19 reported to our knowledge, we suggest that this may be a rare vaccine-related event.
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Affiliation(s)
- Shima Aran
- Division of Radiology, Detroit Receiving Hospital/University Health Network 3L8, 4201 St Antoine Blvd, Detroit, MI 48201, USA
| | - Orest O. Kayder
- Division of Radiology, Detroit Receiving Hospital/University Health Network 3L8, 4201 St Antoine Blvd, Detroit, MI 48201, USA
- Corresponding author.
| | - Teena Chopra
- Division of Infectious Diseases, Detroit Medical Center, Detroit Receiving Hospital/University Health Network 2E, 4201 St Antoine Blvd, Detroit, MI 48201, USA
| | - Hani Abujudeh
- Division of Radiology, Detroit Receiving Hospital/University Health Network 3L8, 4201 St Antoine Blvd, Detroit, MI 48201, USA
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32
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Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081105. [PMID: 35892907 PMCID: PMC9332165 DOI: 10.3390/life12081105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/05/2022]
Abstract
Cerebral venous thrombosis (CVT) is a rare type of stroke that may cause an intracranial hypertension syndrome as well as focal neurological deficits due to venous infarcts. MRI with venography is the method of choice for diagnosis, and treatment with anticoagulants should be promptly started. CVT incidence has increased in COVID-19-infected patients due to a hypercoagulability state and endothelial inflammation. CVT following COVID-19 vaccination could be related to vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but severe complication that should be promptly identified because of its high mortality rate. Platelet count, D-dimer and PF4 antibodies should be dosed. Treatment with non-heparin anticoagulants and immunoglobulin could improve recuperation. Development of headache associated with seizures, impaired consciousness or focal signs should raise immediate suspicion of CVT. In patients who received a COVID-19 adenovirus-vector vaccine presenting thromboembolic events, VITT should be suspected and rapidly treated. Nevertheless, vaccination benefits clearly outweigh risks and should be continued.
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33
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Hsieh MH, Yamaguchi Y. Immune Response in Regard to Hypersensitivity Reactions after COVID-19 Vaccination. Biomedicines 2022; 10:biomedicines10071641. [PMID: 35884946 PMCID: PMC9312871 DOI: 10.3390/biomedicines10071641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), is a member of the genus Betacoronavirus. This virus was first detected in December 2019, and the situation quickly escalated to cause a global pandemic within a few months. COVID-19 had caused more than 5.5 million deaths as of January 2022. Hence, the urgency of effective vaccination contributed to the fastest rate of vaccine development seen to date (i.e., within 1.5 years). Despite reports of good vaccine efficacy without severe systemic reactions at the clinical trial stage, hypersensitivity reactions have been reported following worldwide vaccination campaigns. We provide a brief review regarding the structure of SARS-CoV-2. We also review the most acceptable types of vaccines in terms of safety profiles, namely the BNT162b2, mRNA-1273, and AZD1222 vaccines. This review aims to facilitate an understanding of the possible immune mechanisms regarding COVID-19-vaccination-related hypersensitivity reactions, such as thrombosis and thrombocytopenia, cutaneous adverse reactions, myocarditis, and perimyocarditis.
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34
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Mahroum N, Lavine N, Ohayon A, Seida R, Alwani A, Alrais M, Zoubi M, Bragazzi NL. COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review. Front Immunol 2022; 13:872683. [PMID: 35865539 PMCID: PMC9294236 DOI: 10.3389/fimmu.2022.872683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
Despite their proven efficacy and huge contribution to the health of humankind, vaccines continue to be a source of concern for some individuals around the world. Vaccinations against COVID-19 increased the number of distressed people and intensified their distrust, particularly as the pandemic was still emerging and the populations were encouraged to be vaccinated under various slogans like “back to normal life” and “stop coronavirus”, goals which are still to be achieved. As fear of vaccination-related adverse events following immunization (AEFIs) is the main reason for vaccine hesitancy, we reviewed immune and autoimmune AEFIs in particular, though very rare, as the most worrisome aspect of the vaccines. Among others, autoimmune AEFIs of the most commonly administered COVID-19 vaccines include neurological ones such as Guillain-Barre syndrome, transverse myelitis, and Bell’s palsy, as well as myocarditis. In addition, the newly introduced notion related to COVID-19 vaccines, “vaccine-induced immune thrombotic thrombocytopenia/vaccine-induced prothrombotic immune thrombotic thrombocytopenia” (VITT/VIPITT)”, is of importance as well. Overviewing recent medical literature while focusing on the major immune and autoimmune AEFIs, demonstrating their rate of occurrence, presenting the cases reported, and their link to the specific type of COVID-19 vaccines represented the main aim of our work. In this narrative review, we illustrate the different vaccine types in current use, their associated immune and autoimmune AEFIs, with a focus on the 3 main COVID-19 vaccines (BNT162b2, mRNA-1273, and ChAdOx1). While the rate of AEFIs is extremely low, addressing the issue in this manner, in our opinion, is the best strategy for coping with vaccine hesitancy.
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Affiliation(s)
- Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Noy Lavine
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
- St. George School of Medicine, University of London, London, United Kingdom
| | - Aviran Ohayon
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
- St. George School of Medicine, University of London, London, United Kingdom
| | - Ravend Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulkarim Alwani
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mahmoud Alrais
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Magdi Zoubi
- Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- *Correspondence: Nicola Luigi Bragazzi,
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35
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Naeem FN, Hasan SFS, Ram MD, Waseem S, Ahmed SH, Shaikh TG. The association between SARS-CoV-2 vaccines and transverse myelitis: A review. Ann Med Surg (Lond) 2022; 79:103870. [PMID: 35702684 PMCID: PMC9181565 DOI: 10.1016/j.amsu.2022.103870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 12/02/2022] Open
Abstract
In late 2019, the emergence of a new viral strain, later referred to as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) took the shape of a global pandemic, affecting millions of lives and deteriorating economies around the globe. Vaccines were developed at an exceptional rate to combat the viral desolation, all of them being rolled out once they displayed sufficient safety and efficacy. However, assorted adverse events came into attention, one of them being Transverse Myelitis (TM), an infrequent, immune-mediated, focal disease of the spinal cord. This disorder can lead to severe neurological complications including autonomic, sensory, and motor deficits. The literature aims to shed light on TM and its various etiologies, specifically in line with the vaccine, and a comprehensive treatment plan. Discussing and reducing the number of vaccines related adverse events can help succor in bringing down the vaccine hesitancy and ultimately combatting the pandemic.
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36
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Frere C, Salem JE. Commentary on "Risk of venous thromboembolism after COVID-19 vaccination". J Thromb Haemost 2022; 20:1562-1564. [PMID: 35754009 PMCID: PMC9771186 DOI: 10.1111/jth.15735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Corinne Frere
- UNICO-GRECO Cardio-Oncology Program, INSERM UMRS_1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
- Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joe-Elie Salem
- UNICO-GRECO Cardio-Oncology Program, INSERM UMRS_1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
- Department of Pharmacology, Clinical Investigation Center-1901, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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37
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Houghton DE, Wysokinski W, Casanegra AI, Padrnos LJ, Shah S, Wysokinska E, Pruthi R, Ashrani A, Sridharan M, Baumann-Kreuziger L, McBane R, Padmanabhan A. Risk of venous thromboembolism after COVID-19 vaccination. J Thromb Haemost 2022; 20:1638-1644. [PMID: 35398975 PMCID: PMC9115120 DOI: 10.1111/jth.15725] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND COVID-19 vaccinations in the United States are effective in preventing illness and hospitalization yet concern over post-vaccination venous thromboembolism (VTE) risk has led to vaccine hesitancy. METHODS The aim of this study was to compare VTE rates before and after COVID-19 vaccination. COVID-19 vaccinated patients ≥18 years between November 1, 2020 through November 1, 2021 were analyzed using electronic medical records across the Mayo Clinic enterprise. The primary outcome was imaging confirmed acute VTE (upper or lower deep vein thrombosis or pulmonary embolism) occurring 90 days before and after the date of first vaccine dose. RESULTS A total of 792 010 patients with at least one COVID-19 vaccination were identified (Pfizer, n = 452 950, Moderna, n = 290 607, and Janssen [Johnson & Johnson], n = 48 453). A total of 1565 VTE events occurred in the 90 days before (n = 772) and after (n = 793) COVID-19 vaccination. VTE post-vaccination occurred in 326 patients receiving Moderna (0.11%, incidence rate [IR] 4.58 per 1000p-years), 425 patients receiving Pfizer (0.09%, IR 3.84 per 1000p-years), and 42 receiving Janssen (0.09%, IR 3.56 per 1000p-years). Compared to the pre-vaccination timeframe, the adjusted hazard ratio (aHR) for VTE after the Janssen vaccination was 0.97 (95% confidence interval [CI] 0.63-1.50), aHR 1.02 (95% CI 0.87-1.19) for Moderna, and aHR 1.00 (95% CI 0.87-1.15) for Pfizer. CONCLUSION In this large cohort of COVID-19 vaccinated patients, no increased risk for acute VTE post-vaccination was identified for the authorized vaccines in the United States.
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Affiliation(s)
- Damon E Houghton
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Waldemar Wysokinski
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ana I Casanegra
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Leslie J Padrnos
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Surbhi Shah
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Ewa Wysokinska
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rajiv Pruthi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aneel Ashrani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Meera Sridharan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Baumann-Kreuziger
- Division of Hematology/Oncology, Department of Internal Medicine, Versiti, Milwaukee, Wisconsin, USA
| | - Robert McBane
- Division of Vascular Medicine, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Anand Padmanabhan
- Divisions of Hematopathology, Transfusion Medicine & Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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38
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Kolahchi Z, Khanmirzaei M, Mowla A. Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review. J Neurol Sci 2022; 439:120327. [PMID: 35752132 PMCID: PMC9212261 DOI: 10.1016/j.jns.2022.120327] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
Introduction One of the rare but potentially serious side effects of COVID-19 vaccination is arterial and venous thrombosis. Acute ischemic stroke (AIS) cases have been reported post COVID-19 vaccination. Herein, we systematically reviewed the reported cases of AIS after COVID-19 vaccination. Method This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched PubMed and Scopus until April 14, 2022 to find studies that reported AIS post COVID-19 vaccination. Results We found 447 articles. From those, 140 duplicates were removed. After screening and excluding irrelevant articles, 29 studies (43 patients) were identified to be included. From all cases, 22 patients (51.1%) were diagnosed with AIS associated with Vaccine-induced immune thrombotic thrombocytopenia (VITT). Among AIS associated with VITT group, all received viral vector vaccines except one. The majority of cases with AIS and VITT were female (17 cases, 77.2%) and aged below 60 years (15 cases, 68%). Fourteen patients (32.5%) had additional thrombosis in other sites. Four of them (0.09%) showed concurrent CVST and ischemic stroke. Hemorrhagic transformation following AIS occurred in 7 patients (16.27%). Among 43 patients with AIS, at least 6 patients (14%) died during hospital admission. Conclusion AIS has been reported as a rare complication within 4 weeks post COVID-19 vaccination, particularly with viral vector vaccines. Health care providers should be familiar with this rare consequence of COVID-19 vaccination in particular in the context of VITT to make a timely diagnosis and appropriate treatment plan.
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Affiliation(s)
| | | | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA, USA.
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39
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Mingot-Castellano ME, Butta N, Canaro M, del Carmen Gómez del Castillo Solano M, Sánchez-González B, Jiménez-Bárcenas R, Pascual-Izquierdo C, Caballero-Navarro G, Entrena Ureña L, José González-López T. COVID-19 Vaccines and Autoimmune Hematologic Disorders. Vaccines (Basel) 2022; 10:vaccines10060961. [PMID: 35746569 PMCID: PMC9231220 DOI: 10.3390/vaccines10060961] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
Worldwide vaccination against SARS-CoV-2 has allowed the detection of hematologic autoimmune complications. Adverse events (AEs) of this nature had been previously observed in association with other vaccines. The underlying mechanisms are not totally understood, although mimicry between viral and self-antigens plays a relevant role. It is important to remark that, although the incidence of these AEs is extremely low, their evolution may lead to life-threatening scenarios if treatment is not readily initiated. Hematologic autoimmune AEs have been associated with both mRNA and adenoviral vector-based SARS-CoV-2 vaccines. The main reported entities are secondary immune thrombocytopenia, immune thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, Evans syndrome, and a newly described disorder, so-called vaccine-induced immune thrombotic thrombocytopenia (VITT). The hallmark of VITT is the presence of anti-platelet factor 4 autoantibodies able to trigger platelet activation. Patients with VITT present with thrombocytopenia and may develop thrombosis in unusual locations such as cerebral beds. The management of hematologic autoimmune AEs does not differ significantly from that of these disorders in a non-vaccine context, thus addressing autoantibody production and bleeding/thromboembolic risk. This means that clinicians must be aware of their distinctive signs in order to diagnose them and initiate treatment as soon as possible.
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Affiliation(s)
- María Eva Mingot-Castellano
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), 41013 Sevilla, Spain
- Correspondence:
| | - Nora Butta
- Hospital Universitario La Paz-IdiPAZ, 28046 Madrid, Spain;
| | - Mariana Canaro
- Hematology Department, Hospital Universitario Son Espases, 07210 Palma, Spain;
| | | | | | | | - Cristina Pascual-Izquierdo
- Department of Hematology, Gregorio Marañón General University Hospital (HGUGM) Madrid, Instituto de Investigación Gregorio Marañón, 28009 Madrid, Spain;
| | | | - Laura Entrena Ureña
- Hematology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
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40
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Luciano PQ, Binatti R, Sodré AR, Zajac SR, Marson FAL, Ortega MM. Vaccine-induced immune thrombotic thrombocytopenia after ChAdOx1 nCoV-19 vaccine in an older patient: Minireview and a case report. J Infect Public Health 2022; 15:638-642. [PMID: 35580449 DOI: 10.1016/j.jiph.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/18/2022] [Accepted: 04/17/2022] [Indexed: 12/11/2022] Open
Abstract
Rare cases of unusual thrombosis and thrombocytopenia after administration of the ChAdOx1 nCoV-19 vaccine (AstraZeneca) have been reported. The unusual symptoms are called vaccine-induced immune thrombotic thrombocytopenia (VITT). In the present study, a brief background about cases of unusual thrombosis and thrombocytopenia after administration of the ChAdOx1 nCoV-19 was provided. In addition, a description of a case of a 66-year-old woman who had received this vaccine and developed VITT was done. She presented to the hospital complaining of hematomas in the right upper limb 14 days after the ChAdOx1 nCoV-19 vaccine, without a history of trauma (Glasgow coma scale of 14) and thrombocytopenia even though signs of thrombosis were absent. Cranium computed tomography scan indicated intraparenchymal hematoma and cerebral thrombosis, besides anastomotic Labbé vein thrombosis. The woman received platelets transfusion, dexamethasone, and neuroprotection measures, but even so, on the twelfth postoperative day, she died of cerebral rebleeding. In conclusion, it is crucial to point out the immuno-hypersensitivity mechanisms associated with ChAdOx1 nCoV-19 vaccine reactions, helping to reduce their occurrences and reinforcing confidence in vaccine administration.
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Affiliation(s)
- Paulo Queiroz Luciano
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil; Department of Neurology Surgery, São Francisco University Medical Hospital, Bragança Paulista, SP, Brazil
| | - Renan Binatti
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil
| | - André Rodrigues Sodré
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil
| | | | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil
| | - Manoela Marques Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.
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El Khoury R, Tammana V, Patton J, Jacobs CE, White JV, Schwartz LB. Small popliteal aneurysm thrombosis after SARS-CoV-2 vaccination. J Vasc Surg Cases Innov Tech 2022; 8:298-299. [PMID: 35578624 PMCID: PMC9095077 DOI: 10.1016/j.jvscit.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Rym El Khoury
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Vikram Tammana
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jill Patton
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Chad E Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
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Gendron N, Khider L, Le Beller C, Espinasse B, Auditeau C, Amara W, Perrin G, Lebeaux D, Gaiffe A, Combret S, Bertin B, Lillo-Le Louet A, Mirault T, Smadja DM, Sanchez O, Tromeur C, Planquette B, Couturaud F. Bleeding risk of intramuscular injection of COVID-19 vaccines in adult patients with therapeutic anticoagulation. J Thromb Haemost 2022; 20:1507-1510. [PMID: 35315198 PMCID: PMC9115221 DOI: 10.1111/jth.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Nicolas Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Lina Khider
- Université de Paris, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Christine Le Beller
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Département de Pharmacovigilance, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Benjamin Espinasse
- Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Département de Médecine Interne, Vasculaire et Pneumologie, INSERM U1304 GETBO, CIC1412, Brest, France
- F-CRIN INNOVTE, Saint-Étienne, France
| | - Claire Auditeau
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Wafa Amara
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Germain Perrin
- Université de Paris, Sorbonne Université, Cordeliers Research Centre, INSERM, Paris, France
- HeKA, Inria, Paris, France
- Département de Pharmacie, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - David Lebeaux
- Université de Paris, Microbiologie, Unité Mobile d'Infectiologie, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Anais Gaiffe
- Centre de Pharmacovigilance et d'information sur le Médicament de Franche-Comté, CHU de Besançon, Besançon, France
| | - Sandrine Combret
- Centre Régional de Pharmacovigilance de Bourgogne, CHU de Dijon, Dijon, France
| | - Blandine Bertin
- Centre Régional de Pharmacovigilance de Lyon, Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils De Lyon, Lyon, France
| | - Agnès Lillo-Le Louet
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Département de Pharmacovigilance, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Tristan Mirault
- Université de Paris, Vascular Medicine Department, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
- PARCC, INSERM U970, Paris, France
| | - David M Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- F-CRIN INNOVTE, Saint-Étienne, France
| | - Olivier Sanchez
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- F-CRIN INNOVTE, Saint-Étienne, France
- Respiratory Medicine Department, Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Cécile Tromeur
- Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Département de Médecine Interne, Vasculaire et Pneumologie, INSERM U1304 GETBO, CIC1412, Brest, France
- F-CRIN INNOVTE, Saint-Étienne, France
| | - Benjamin Planquette
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
- F-CRIN INNOVTE, Saint-Étienne, France
- Respiratory Medicine Department, Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Paris, France
| | - Francis Couturaud
- Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Département de Médecine Interne, Vasculaire et Pneumologie, INSERM U1304 GETBO, CIC1412, Brest, France
- F-CRIN INNOVTE, Saint-Étienne, France
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GÜVEN O, TUNA L, GEÇİCİ İA, DURGUN ZS, IŞIK Ö. ARTERIAL AND VENOUS EMBOLISM DUE TO COVID-19 VACCINE (BIONTECH): CASE SERIES. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1089785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction: Although the most prominent effect of Corona disease, respiratory disease it disrupts the vascular structure and causes vascular occlusion. Intravascular coagulation, has also begun to be observed in people who have been vaccinated. Therefore, clinicians had to add anti-coagulants or antiaggregants to the treatment.
Case Reports: In this article; We will try to present the patient who developed arterial and venous embolism after BioNTech vaccine. These patients without known vascular disease responded well to treatment.
Conclusion: The rate of sickness dropped after the vaccine was discovered to be the most effective strategy to protect against Covid-19. It was discovered that vaccinated patients exhibited symptoms similar to corona disease but had a moderate course.
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Affiliation(s)
| | - Lale TUNA
- Kırklareli Training and Research Hospital
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Mani A, Ojha V. Thromboembolism after Covid-19 vaccination: a systematic review of such events in 286 patients. Ann Vasc Surg 2022; 84:12-20.e1. [PMID: 35568325 PMCID: PMC9093198 DOI: 10.1016/j.avsg.2022.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/07/2022] [Accepted: 05/01/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Development of vaccines with high efficacy against Covid-19 disease has ushered a new ray of hope in the fight against the pandemic. Thromboembolic events have been reported after administration of vaccines. We aim to systematically review thromboembolic events reported after Covid-19 vaccination. METHODS The available literature was systematically screened for available data on thromboembolic events post Covid-19 vaccination. Data was extracted from selected studies and analysed for site of thromboembolism as well as other risk factors. All data was pooled to determine cumulative incidence of thromboembolism at various sites post vaccination. RESULTS A total of 20 studies were selected for final analysis. The mean age of the population was 48.5 ± 15.4 years (females- 67.4%). Mean time to event post vaccination was 10.8 ± 7.2 days. Venous thrombosis(74.8%, n=214/286) was more common than arterial thrombosis ( 27.9%,n=80/286). Cerebral sinus thrombosis was most common manifestation (28.3%,n=81/286) of venous thrombosis followed by deep vein thrombosis(19.2%,n=49/254). Myocardial infarction was common (20.1%,n=55/274) in patients with arterial thrombosis followed by ischemic stroke (8.02%,n=22/274). Concurrent thrombosis at multiple sites was noted in 15.4% patients. Majority of patients had thrombocytopenia (49%) and anti-platelet factor 4 antibodies (78.6%). Thromboembolic events were mostly reported after Astra-Zeneca vaccine (93.7%). Cerebral sinus thrombosis was most common amongst thromboembolic events reported after Astra-Zeneca vaccine. Amongst the reported cases, mortality was noted in 29.9% patients. CONCLUSION Thromboembolic events can occur after Covid-19 vaccination, most commonly after Astra Zeneca vaccine. Cerebral sinus thrombosis is the most common manifestation noted in vaccinated individuals.
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Affiliation(s)
- Avinash Mani
- Department of Cardiology, Sri Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi-110029, India.
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López-Mena D, García-Grimshaw M, Saldivar-Dávila S, Hernandez-Vanegas LE, Saniger-Alba MDM, Gutiérrez-Romero A, Carrillo-Mezo R, Valdez-Ruvalcaba HE, Cano-Nigenda V, Flores-Silva FD, Cantú-Brito C, Santibañez-Copado AM, Diaz-Ortega JL, Ceballos-Liceaga SE, Murillo-Bonilla LM, Sepulveda-Núñez AI, García-Talavera V, Gonzalez-Guerra E, Cortes-Alcala R, Lopez-Gatell H, Carbajal-Sandoval G, Reyes-Terán G, Valdés-Ferrer SI, Arauz A. Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study. Neurology 2022; 98:e1933-e1941. [PMID: 35277439 PMCID: PMC9141628 DOI: 10.1212/wnl.0000000000200388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Information on stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines remains scarce. We report stroke incidence as an adverse event following immunization (AEFI) among recipients of 79,399,446 doses of 6 different SARS-CoV-2 vaccines (BNT162b2, ChAdOx1 nCov-19, Gam-COVID-Vac, CoronaVac, Ad5-nCoV, and Ad26.COV2-S) between December 24, 2020, and August 31, 2021, in Mexico. METHODS This retrospective descriptive study analyzed stroke incidence per million doses among hospitalized adult patients (≥18 years) during an 8-month interval. According to the World Health Organization, AEFIs were defined as clinical events occurring within 30 days after immunization and categorized as either nonserious or serious, depending on severity, treatment, and hospital admission requirements. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral venous thrombosis (CVT) cases were collected through a passive epidemiologic surveillance system in which local health providers report potential AEFI to the Mexican General Board of Epidemiology. Data were captured with standardized case report formats by an ad hoc committee appointed by the Mexican Ministry of Health to evaluate potential neurologic AEFI against SARS-COV-2. RESULTS We included 56 patients (31 female patients [55.5%]) for an overall incidence of 0.71 cases per 1,000,000 administered doses (95% CI 0.54-0.92). Median age was 65 years (interquartile range [IQR] 55-76 years); median time from vaccination to stroke (of any subtype) was 2 days (IQR 1-5 days). In 27 (48.2%) patients, the event was diagnosed within the first 24 hours after immunization. The most frequent subtype was AIS in 43 patients (75%; 0.54 per 1,000,000 doses, 95% CI 0.40-0.73), followed by ICH in 9 (16.1%; 0.11 per 1,000,000 doses, 95% CI 0.06-0.22) and SAH and CVT, each with 2 cases (3.6%; 0.03 per 1,000,000 doses, 95% CI 0.01-0.09). Overall, the most common risk factors were hypertension in 33 (58.9%) patients and diabetes in 22 (39.3%). Median hospital length of stay was 6 days (IQR 4-13 days). At discharge, functional outcome was good (modified Rankin Scale score 0-2) in 41.1% of patients; in-hospital mortality rate was 21.4%. DISCUSSION Stroke is an exceedingly rare AEFI against SARS-CoV-2. Preexisting stroke risk factors were identified in most patients. Further research is needed to evaluate causal associations between SARS-COV-2 vaccines and stroke.
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Affiliation(s)
- Diego López-Mena
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Miguel García-Grimshaw
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Sergio Saldivar-Dávila
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Laura Elena Hernandez-Vanegas
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - María Del Mar Saniger-Alba
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Alonso Gutiérrez-Romero
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Roger Carrillo-Mezo
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Hector Eduardo Valdez-Ruvalcaba
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Vanessa Cano-Nigenda
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Fernando Daniel Flores-Silva
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Carlos Cantú-Brito
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ana María Santibañez-Copado
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Jose-Luis Diaz-Ortega
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Santa Elizabeth Ceballos-Liceaga
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Luis Manuel Murillo-Bonilla
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ana Isabel Sepulveda-Núñez
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Verónica García-Talavera
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Eduardo Gonzalez-Guerra
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ricardo Cortes-Alcala
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Hugo Lopez-Gatell
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Guillermo Carbajal-Sandoval
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Gustavo Reyes-Terán
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Sergio Iván Valdés-Ferrer
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Antonio Arauz
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
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Chatterton S, Mason GA, Cook R, Davidson K, Ward C, Ng K. Arterial thrombosis following first-dose ChAdOx1 vaccination: a case series. BMJ Neurol Open 2022; 4:e000270. [PMID: 35571586 PMCID: PMC9082725 DOI: 10.1136/bmjno-2022-000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/27/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Medical School, University of NSW, Sydney, New South Wales, Australia
| | - George Albert Mason
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Raymond Cook
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Keryn Davidson
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Christopher Ward
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Karl Ng
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Neurology and Clinical Neurophysiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Vallone MG, Falcón AL, Castro HM, Ferraris A, Cantarella RF, Staneloni MI, Aliperti VI, Ferloni A, Mezzarobba D, Vázquez FJ, Ratti MFG. Thrombotic events following Covid-19 vaccines compared to Influenza vaccines. Eur J Intern Med 2022; 99:82-88. [PMID: 35288031 PMCID: PMC8904150 DOI: 10.1016/j.ejim.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 12/22/2022]
Abstract
IMPORTANCE The actual risk of thrombotic events after Covid-19 vaccination is unknown. OBJECTIVE To evaluate the risk of thrombotic events after Covid-19 vaccination. DESIGN Retrospective cohort study which included consecutive adult patients vaccinated with the first dose of Covid-19 vaccine between January 1 and May 30, 2021, and a historic control group, defined as consecutive patients vaccinated with influenza vaccine between March 1 and July 30, 2019. SETTING Hospital Italiano de Buenos Aires, a tertiary hospital in Argentina. PARTICIPANTS Non-Hospitalized Adults vaccinated with the first dose of a Covid-19 vaccine. EXPOSURE Vaccination with Covid-19 vaccines available during the study period: Gam-COVID-Vac (Sputnik), ChAdOx1 nCoV-19 (AstraZeneca/Oxford or Covishield), BBIBP-CorV (Beijing Institute of Biological Products) (Sinopharm). Active comparator group exposure was Influenza vaccine. MAIN OUTCOME Primary endpoint was cumulative incidence of any symptomatic thrombotic event at 30 days, defined as the occurrence of at least one of the following: symptomatic acute deep venous thrombosis (DVT); symptomatic acute pulmonary embolism (PE); acute ischemic stroke (AIS); acute coronary syndrome (ACS) or arterial thrombosis. RESULTS From a total of 29,985 adult patients who received at least a first dose of Covid-19 vaccine during study period and 24,777 who received Influenza vaccine in 2019, we excluded those who were vaccinated during hospitalization. We finally included 29,918 and 24,753 patients respectively. Median age was 73 years old (IQR 75-81) and 67% were females in both groups. Thirty six subjects in the Covid-19 vaccination group (36/29,918) and 15 patients in the Influenza vaccination group (15/24,753) presented at least one thrombotic event. The cumulative incidence of any thrombotic event at 30 days was 12 per 10,000 (95%CI 9-17) for Covid-19 group and 6 per 10,000 (95%CI 4-10) for Influenza group (p-value=0.022). CONCLUSIONS AND RELEVANCE This study shows a significant increase in thrombotic events in subjects vaccinated with Covid-19 vaccines in comparison to a control group. The clinical implication of these findings should be interpreted with caution, in light of the high effectiveness of vaccination and the inherent risk of thrombosis from Covid-19 infection itself.
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Affiliation(s)
- Marcelo Gabriel Vallone
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina.
| | - Andre Luis Falcón
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina
| | - Horacio Matias Castro
- Pulmonology Section, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Augusto Ferraris
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina
| | - Ramiro Francisco Cantarella
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina
| | - María Inés Staneloni
- Infectious Diseases Department, Infection Control Committee, Hospital Italiano de Buenos Aires, Argentina
| | | | - Analia Ferloni
- Investigation Department, Hospital Italiano de Buenos Aires, Argentina
| | - Daniela Mezzarobba
- Hematology Section, Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires, Argentina; Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Javier Vázquez
- Internal Medicine Section, Hospital Italiano de Buenos Aires. J.D. Perón 4190, Ciudad Autónoma de Buenos Aires, C1181ACH, Argentina; CONICET Independent Research
| | - María Florencia Grande Ratti
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; CONICET Independent Research
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Sessa A, Gattamorta M, Punginelli M, Maggioni G. Arterial Thrombosis in an Unusual Site (Ulnar Artery) after COVID-19 Vaccination-A Case Report. Clin Pract 2022; 12:237-242. [PMID: 35645305 PMCID: PMC9150007 DOI: 10.3390/clinpract12030028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Spontaneous events have been reported after COVID-19 vaccination. In this case, we report a thrombotic event in an unusual site (ulnar artery) after COVID-19 vaccination. The patient (69 year-old-male) had no changes after a laboratory investigation regarding thrombophilic pattern, but nevertheless had atherothrombotic predisposing conditions. Arterial thrombotic events have more frequently been reported after mRNA vaccines than after adenovirus vaccines. This is the first case reported of thrombosis of the ulnar artery occurring in the same side of the body where the vaccination took place. However, it must be noted that COVID-19 vaccines cumulatively offer a net positive effect, despite rare adverse effects.
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Affiliation(s)
- Aurelio Sessa
- Internal Medicine Unit, Isber Clinic, I-21100 Varese, Italy
| | | | - Maurizia Punginelli
- Pharmaceutical Service, Territorial Health Service of Insubria, I-21100 Varese, Italy; (M.P.); (G.M.)
| | - Gianluigi Maggioni
- Pharmaceutical Service, Territorial Health Service of Insubria, I-21100 Varese, Italy; (M.P.); (G.M.)
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Palaiodimou L, Stefanou MI, de Sousa DA, Coutinho JM, Papadopoulou M, Papaevangelou V, Vassilakopoulos TI, Tsiodras S, Filippou DK, Tsivgoulis G. Cerebral venous sinus thrombosis in the setting of COVID-19 vaccination: a systematic review and meta-analysis. J Neurol 2022; 269:3413-3419. [PMID: 35394172 PMCID: PMC8990450 DOI: 10.1007/s00415-022-11101-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
Background and Purpose Cerebral venous sinus thrombosis (CVST) has been reported as a rare adverse event in association with thrombosis-thrombocytopenia syndrome (TTS) following COVID-19 vaccination. Methods We performed a systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases, with the aim to calculate (1) the odds ratio of TTS–CVST versus non-TTS–CVST after vector-based vaccines and (2) after non-vector-based vaccines, (3) the in-hospital mortality ratio of TTS–CVST compared to non-TTS–CVST; and (4) the dependency or death at discharge among TTS–CVST compared to non-TTS–CVST cases. Results Two eligible studies were included in the meta-analysis, comprising a total of 211 patients with CVST associated with COVID-19 vaccination. Vector-based COVID-19 vaccination was associated with a higher likelihood of TTS-associated CVST than with non-TTS–CVST (OR: 52.34, 95% CI 9.58–285.98). TTS–CVST was also associated with higher likelihood of in-hospital mortality (OR: 13.29; 95% CI 3.96–44.60) and death or dependency at discharge compared to non-TTS–CVST (OR: 6.70; 95% CI 3.15–14.26). TTS–CVST was recorded with a shorter interval between vaccination and symptom onset [Mean Difference (MD):-6.54 days; 95% CI − 12.64 to − 0.45], affecting younger patients (MD:-9.00 years; 95% CI − 14.02 to − 3.99) without risk factors for thromboses (OR:2.34; 95% CI 1.26–4.33), and was complicated more frequently with intracerebral hemorrhage (OR:3.60; 95% CI 1.31–9.87) and concomitant thromboses in other sites (OR:11.85; 95% CI 3.51–39.98) compared to non-TTS–CVST cases. Conclusions TTS–CVST following COVID-19 vaccination has distinct risk factor profile, clinical phenotype and prognosis compared to non-TTS–CVST. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS–CVST cases following COVID-19 vaccination. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11101-2.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHULN, University of Lisbon, Lisbon, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianna Papadopoulou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Vasiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros I Vassilakopoulos
- Third Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Dimitrios K Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- National Organization for Medicines (EOF), Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece.
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
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Roncati L, Manenti A, Corsi L. A Three-Case Series of Thrombotic Deaths in Patients over 50 with Comorbidities Temporally after modRNA COVID-19 Vaccination. Pathogens 2022; 11:pathogens11040435. [PMID: 35456110 PMCID: PMC9032304 DOI: 10.3390/pathogens11040435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium; to counteract it, specific vaccines have been launched in record time under emergency use authorization or conditional marketing authorization by virtue of a favorable risk/benefit balance. Among the various technological platforms, there is that exploiting a nucleoside-modified messenger RNA (modRNA), such as Comirnaty®, and that which is adenoviral vector-based. In the ongoing pharmacovigilance, the product information of the latter has been updated about the risk of thrombotic thrombocytopenia, venous thromboembolism without thrombocytopenia and immune thrombocytopenia without thrombosis. However, from an in-depth literature review, the same adverse events can rarely occur with modRNA vaccines too. In support of this, we here report a three-case series of thrombotic deaths in patients over 50 with comorbidities temporally after Comirnaty®, investigated by means of post-mortem histopathology and immunohistochemistry. In two out of three cases, the cause of death is traced back to pulmonary microthromboses rich in activated platelets, quite similar morphologically to those described in patients who died from severe COVID-19. Even if remote in the face of millions of administered doses, clinicians should be aware of the possible thrombotic risk also after Comirnaty®, in order to avoid a misdiagnosis with potentially lethal consequences. Since COVID-19 vaccines are inoculated in subjects to be protected, maximum attention must be paid to their safety, and prophylactic measures to increase it are always welcome. In light of the evidence, the product information of modRNA COVID-19 vaccines should be updated about the thrombotic risk, as happened for adenoviral vector-based vaccines.
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Affiliation(s)
- Luca Roncati
- Institute of Pathology, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: or or
| | - Antonio Manenti
- Unit of Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Lorenzo Corsi
- Department of Life Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- National Institute of Biostructures and Biosystems, Inter-University Consortium, 00136 Rome, Italy
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