SARS-CoV-2 Vaccine and Thrombosis: An Expert Consensus on Vaccine-Induced Immune Thrombotic Thrombocytopenia

Ismail Elalamy; Grigoris Gerotziafas; Sonia Alamowitch; Jean-Pierre Laroche; Patrick Van Dreden; Walter Ageno; Jan Beyer-Westendorf; Alexander T. Cohen; David Jimenez; Benjamin Brenner; Saskia Middeldorp; Patrice Cacoub; Scientific Reviewer Committee

doi:10.1055/a-1499-0119

Thrombosis and Haemostasis, Table of Contents

CC BY-NC-ND 4.0 · Thromb Haemost 2021; 121(08): 982-991
DOI: 10.1055/a-1499-0119

Consensus Paper

SARS-CoV-2 Vaccine and Thrombosis: An Expert Consensus on Vaccine-Induced Immune Thrombotic Thrombocytopenia

Ismail Elalamy

¹Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France

²Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

³Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia

,

Grigoris Gerotziafas

¹Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France

²Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

,

Sonia Alamowitch

⁴AP-HP, Service des Urgences cérébro-vasculaires, Hôpital Pitié-Salpétrière, Paris, France

⁵Centre de recherche de Saint Antoine, INSERM, UMRS 938, Sorbonne Université Paris, France

,

Jean-Pierre Laroche

⁶Service de médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, Montpellier cedex 5, France

⁷Médipôle, 1139, chemin du Lavarin, Avignon, France

,

Patrick Van Dreden

²Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

,

Walter Ageno

⁸Department of Emergency Medicine and Thrombosis Center, Ospedale di Circolo and Department of Medicine and Surgery, University of Insubria, Varese, Italy

,

Jan Beyer-Westendorf

⁹Department of Medicine I, Division of Haematology and Haemostaseology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

Alexander T. Cohen

¹⁰Department of Haematological Medicine, Guys and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom

,

David Jimenez

¹¹Respiratory Department, Ramon y Cajal Hospital (IRYCIS), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

,

Benjamin Brenner

³Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia

¹²Department of Hematology, Rambam Health Care Campus, Haifa, Israel

,

Saskia Middeldorp

¹³Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands

,

Patrice Cacoub

¹⁴Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France

¹⁵Institut National de la Santé et de la Recherche Médicale, INSERM, Paris, France

¹⁶CNRS, FRE3632, Paris, France

¹⁷Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, Paris, France

,

Scientific Reviewer Committee

› Author Affiliations

Abstract

Historically, the vaccination strategies developed in the second half of the 20th century have facilitated the eradication of infectious diseases. From the onset of COVID-19 pandemic to the end of April 2021, more than 150 million cases and 3 million deaths were documented worldwide with disruption of the economic and social activity, and with devastating material, physical, and psychological consequences. Reports of unusual and severe thrombotic events, including cerebral and splanchnic venous thrombosis and other autoimmune adverse reactions, such as immune thrombocytopenia or thrombotic microangiopathies in connection with some of the SARS-CoV-2 vaccines, have caused a great deal of concern within the population and the medical community. This report is intended to provide practical answers following an overview of our knowledge on these thrombotic events that are extremely rare but have serious consequences. Vaccine hesitancy threatens to reverse the progress made in controlling vaccine-preventable diseases. These adverse events must be put into perspective with an objective analysis of the facts and the issues of the vaccination strategy during this SARS-CoV-2 pandemic. Health care professionals remain the most pertinent advisors and influencers regarding vaccination decisions; they have to be supported to provide reliable and credible information on vaccines. We need to inform, reassure, and support our patients when the prescription is made. Facing these challenges and observations, a panel of experts express their insights and propose a tracking algorithm for vaccinated patients based on a 10-point guideline for decision-making on what to do and not to do.

Keywords

SARS-CoV-2 - vaccination - thrombosis - VITT

Full Text

References

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