PDF(Pubmed)
Abstract：
Rare but serious thrombotic incidents in relation to thrombocytopenia, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), have been observed since the vaccine rollout, particularly among replication-defective adenoviral vector-based severe acute respiratory syndrome coronavirus 2 vaccine recipients. Herein, we comprehensively reviewed and summarized reported studies of VITT following the coronavirus disease 2019 (COVID-19) vaccination to determine its prevalence, clinical characteristics, as well as its management. A literature search up to October 1, 2021 using PubMed and SCOPUS identified a combined total of 720 articles. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, after screening the titles and abstracts based on the eligibility criteria, the remaining 47 full-text articles were assessed for eligibility and 29 studies were included. Findings revealed that VITT cases are strongly related to viral vector-based vaccines, which are the AstraZeneca COVID-19 vaccine (95%) and the Janssen COVID-19 vaccine (4%), with much rarer reports involving messenger RNA-based vaccines such as the Moderna COVID-19 vaccine (0.2%) and the Pfizer COVID-19 vaccine (0.2%). The most severe manifestation of VITT is cerebral venous sinus thrombosis with 317 cases (70.4%) and the earliest primary symptom in the majority of cases is headache. Intravenous immunoglobulin and non-heparin anticoagulant are the main therapeutic options for managing immune responses and thrombosis, respectively. As there is emerging knowledge on and refinement of the published guidelines regarding VITT, this review may assist the medical communities in early VITT recognition, understanding the clinical presentations, diagnostic criteria as well as its management, offering a window of opportunity to VITT patients. Further larger sample size trials could further elucidate the link and safety profile.
摘要：
与血小板减少症相关的罕见但严重的血栓性事件，称为疫苗诱导的免疫性血栓性血小板减少症（VITT），自疫苗推出以来一直被观察到，特别是在基于复制缺陷型腺病毒载体的严重急性呼吸综合征冠状病毒2疫苗接种者中.在这里，我们全面回顾和总结了2019年冠状病毒病（COVID-19）疫苗接种后VITT的报告研究，以确定其患病率，临床特征,以及它的管理。截至2021年10月1日，使用PubMed和SCOPUS进行的文献检索总共确定了720篇文章。遵循PRISMA（系统审查和荟萃分析的首选报告项目）指南，在根据资格标准筛选标题和摘要后，对其余47篇全文进行了合格性评估,纳入了29项研究.研究结果表明，VITT病例与基于病毒载体的疫苗密切相关，其中包括阿斯利康COVID-19疫苗(95%)和扬森COVID-19疫苗(4%)，更罕见的报道涉及基于信使RNA的疫苗，如ModernaCOVID-19疫苗(0.2%)和辉瑞COVID-19疫苗(0.2%)。VITT最严重的表现是脑静脉窦血栓形成317例（70.4%），大多数病例的首发症状是头痛。静脉免疫球蛋白和非肝素抗凝剂是管理免疫反应和血栓形成的主要治疗选择。分别。随着对已发布的VITT指南的了解和完善，这项审查可能有助于医学界早期VITT认可，了解临床表现，诊断标准及其管理，为VITT患者提供机会之窗。进一步更大的样本量试验可以进一步阐明链接和安全性。
