NEJM: Find a cure for fatal venous thrombosis after adenovirus vaccination

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NEJM: Find a cure for fatal venous thrombosis after adenovirus vaccination

NEJM: Find a cure for fatal venous thrombosis after adenovirus vaccination.  Thrombocytopenia and thrombosis (VITT) caused by the two adenovirus vector COVID-19 vaccines of AstraZeneca in the United Kingdom and Johnson & Johnson in the United States is the vaccine news that has attracted many people’s attention this year.

On June 9, 2021, the New England Journal of Medicine (NJEM) published an important article from McMaster University in Canada, stating that VITT can be corrected through traditional intravenous immunoglobulin (IVIg) injection therapy.

The study selected 3 first patients who developed VITT after receiving the AstraZeneca vaccine AZD1222. The patients were between 63-72 years old; one was a female. Two patients had limb arterial thrombosis; the third patient had cerebral venous and arterial thrombosis.

Studies have observed different patterns of heparin and platelet factor 4 (PF4) in inducing platelet activation, indicating the heterogeneity of the pathogenesis of VITT.

However, after IVIG was administered, antibody-induced platelet activation reduction in serum was observed in all three patients, and PF4-polyanion antibody disappeared in two patients.

Therefore, the author believes that IVIG therapy may be an effective way to interfere with VITT. This study is of great significance to countries that lack vaccines and have to use vaccines such as AZD1222. Therefore, it is worthwhile to carry out further relevant clinical studies.

• The three case reports of McMaster University in Canada were able to be published in NEJM because the thrombosis events associated with the adenovirus vector vaccine were too serious. 
• US CDC publishes cases of Johnson & Johnson vaccine-related cerebral venous sinus thrombosis and finds risk factors
• The White House: A complete suspension of the Johnson & Johnson COVID-19 vaccine. We have conducted a comprehensive review of the associated fatal thrombosis

In addition to adenovirus vector vaccines related to thrombosis, the University of Edinburgh research also provided that the AstraZeneca vaccine caused a series of severe coagulation abnormalities.

On June 9th, 2021, the University of Edinburgh reported in the journal Nature Medicine on thrombocytopenia and thrombosis after vaccination against COVID-19 in Scotland.

The study reviewed the SCCS data and found an association between AstraZeneca vaccine ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 days after vaccination, aRR = 5.77). 0-27 days after vaccination, the risk of arterial thromboembolic events also increases (aRR = 1.22). For bleeding events 0-27 days after vaccination, the aRR is 1.48.

The study found that the first dose of ChAdOx1 is related to the increased risk of ITP, and the increased risk of arterial thromboembolism and bleeding events.

Although AstraZeneca adenovirus vector vaccine is closely related to abnormal blood coagulation function after vaccination, in the face of the dangerous COVID-19 epidemic, countries continue to vaccinate adenovirus vector vaccine after weighing the pros and cons.

On June 8, 2021, the University of Oxford reported in Nat Med on the real-world protection of the two vaccinations BNT162b2 and ChAdOx1-nCoV-19 (AZD1222) in the UK, again demonstrating the necessity of vaccination.

The study analyzed 1,945,071 real-time PCR results collected from 383,812 subjects from December 1, 2020 to May 8, 2021, and found that 21 days after the first dose of ChAdOx1 or BNT162b2 vaccine, there was a reduction of 61% and 66%. Symptomatic and asymptomatic infections. After two vaccinations, the protective power of the two vaccines was 79% and 80%, respectively.

Vaccination can also significantly relieve symptoms and reduce the viral load after infection.

Editor’s note:

The above three studies show that even if it is associated with fatal thrombosis, humans still need to continue to use adenovirus vector vaccines; therefore, the discovery of IVIG as an effective treatment is too important for patients who have VITT after using adenovirus.

Case reports are often the beginning of new discoveries, and RCT studies are the end points for confirming new discoveries. Looking forward to further verification in the future.

(source:internet, reference only)

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