Treatment, outcome and re-vaccination of patients with SARS-CoV-2 vaccine-associated immune thrombocytopenia

Abstract <jats:underline>Purpose</jats:underline>:Following the emergency use authorization of BNT162b2 by the Food and Drug administration (FDA) in early December 2020, mRNA- and vector-based vaccines became an important means of reducing the spread and mortality of the COVID-19 pandemic. The European Medicines Agency labelled immune thrombocytopenia (ITP) as a rare adverse reaction of unknown frequency after vector-, but not mRNA-vaccination. Here, we report on the long-term outcome of 6 patients who were diagnosed with de-novo, vaccine-associated ITP (VA-ITP), and on the outcome of subsequent SARS-CoV-2 re-vaccinations.<jats:underline>Methods</jats:underline>: Patients were included after presenting to our emergency department. Therapy was applied according to ITP guidelines. Follow-up data were obtained from outpatient departments. Both mRNA- or vector-based vaccines were each used in 3 cases, respectively.<jats:underline>Results</jats:underline>:In all patients, the onset of symptoms occurred after the 1st dose of vaccine was applied. 5 patients required treatment, 3 of them 2nd line therapy. All patients showed a complete response eventually. After up to 359 days of follow-up, 2 patients were still under 2nd line therapy with thrombopoietin receptor agonists. 5 patients have been re‑vaccinated with up to 3 consecutive doses of SARS-CoV-2 vaccines, 4 of them showing stable platelet counts hereafter. <jats:underline>Conclusion</jats:underline>:Thrombocytopenia after COVID-19 vaccination should trigger a diagnostic workup to exclude vaccine-induced immune thrombotic thrombocytopenia (VITT) and, if confirmed, VA-ITP should be treated according to current ITP guidelines. Re-vaccination of patients seems feasible under close monitoring of blood counts and using a vaccine that differs from the one triggering the initial episode of VA-ITP..

Medienart:	Preprint

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	ResearchSquare.com - (2022) vom: 19. Juli Zur Gesamtaufnahme - year:2022

Sprache:	Englisch

Beteiligte Personen:	Ruzicka, Michael [VerfasserIn] Wurm, Sonja [VerfasserIn] Lindner, Lars [VerfasserIn] Dreyling, Martin [VerfasserIn] von Bergwelt-Baildon, Michael [VerfasserIn] Boeck, Stefan [VerfasserIn] Giessen-Jung, Clemens [VerfasserIn] Milani, Valeria [VerfasserIn] Stemmler, Hans Joachim [VerfasserIn] Subklewe, Marion [VerfasserIn] Weigert, Oliver [VerfasserIn] Spiekermann, Karsten [VerfasserIn]

Links:	Volltext [kostenfrei]

doi:	10.21203/rs.3.rs-1859299/v1

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PPN (Katalog-ID):	XRA036577162