Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases
Abstract Background ChAdOx1 nCoV-19 (AstraZeneca) and Ad26COV2.S (Johnson & Johnson/Janssen) adenoviral vector vaccines have been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). Arterial thrombosis and acute limb ischemia have been described in a minority of patients w...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Thrombosis Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12959-022-00398-8 |
| _version_ | 1811323584961839104 |
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| author | Guillaume Roberge Benoit Côté Anthony Calabrino Nathalie Gilbert Nathalie Gagnon |
| author_facet | Guillaume Roberge Benoit Côté Anthony Calabrino Nathalie Gilbert Nathalie Gagnon |
| author_sort | Guillaume Roberge |
| collection | DOAJ |
| description | Abstract Background ChAdOx1 nCoV-19 (AstraZeneca) and Ad26COV2.S (Johnson & Johnson/Janssen) adenoviral vector vaccines have been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). Arterial thrombosis and acute limb ischemia have been described in a minority of patients with VITT. These patients usually need a revascularization, but they potentially are at a higher risk of complications. Optimal perioperative care of patients undergoing vascular surgery in acute VITT is unknown and important considerations in such context need to be described. Cases presentations We report 2 cases of VITT presenting with acute limb ischemia who needed vascular surgery and we describe the multidisciplinary team decisions for specific treatment surrounding the interventions. Both patients’ platelet counts initially increased after either intravenous immune globulin (IVIG) or therapeutic plasma exchange (TPE). None received platelet transfusion. They both received argatroban as an alternative to heparin for their surgery. Despite persistent positivity of anti-platelet factor 4 (PF4) antibodies and serotonin-release assay with added PF4 (PF4-SRA) in both patients, only one received a repeated dose of IVIG before the intervention. Per- and post-operative courses were both unremarkable. Conclusion In spite of persistent anti-PF4 and PF4-SRA positivity in the setting of VITT, after platelet count improvement using either IVIG or TPE, vascular interventions using argatroban can show favorable courses. Use of repeated IVIG or TPE before such interventions still needs to be defined. |
| first_indexed | 2024-04-13T13:57:48Z |
| format | Article |
| id | doaj.art-94d2924c7ad24eca95ec6c90a742123d |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-04-13T13:57:48Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-94d2924c7ad24eca95ec6c90a742123d2022-12-22T02:44:08ZengBMCThrombosis Journal1477-95602022-07-012011610.1186/s12959-022-00398-8Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 casesGuillaume Roberge0Benoit Côté1Anthony Calabrino2Nathalie Gilbert3Nathalie Gagnon4Centre d’Excellence Des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d’Assise, Université LavalDepartment of General Internal Medicine, Centre Hospitalier Universitaire de Québec, Hôpital de L’Enfant-Jésus, Université LavalCentre d’Excellence Des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d’Assise, Université LavalCentre d’Excellence Des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d’Assise, Université LavalCentre d’Excellence Des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d’Assise, Université LavalAbstract Background ChAdOx1 nCoV-19 (AstraZeneca) and Ad26COV2.S (Johnson & Johnson/Janssen) adenoviral vector vaccines have been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). Arterial thrombosis and acute limb ischemia have been described in a minority of patients with VITT. These patients usually need a revascularization, but they potentially are at a higher risk of complications. Optimal perioperative care of patients undergoing vascular surgery in acute VITT is unknown and important considerations in such context need to be described. Cases presentations We report 2 cases of VITT presenting with acute limb ischemia who needed vascular surgery and we describe the multidisciplinary team decisions for specific treatment surrounding the interventions. Both patients’ platelet counts initially increased after either intravenous immune globulin (IVIG) or therapeutic plasma exchange (TPE). None received platelet transfusion. They both received argatroban as an alternative to heparin for their surgery. Despite persistent positivity of anti-platelet factor 4 (PF4) antibodies and serotonin-release assay with added PF4 (PF4-SRA) in both patients, only one received a repeated dose of IVIG before the intervention. Per- and post-operative courses were both unremarkable. Conclusion In spite of persistent anti-PF4 and PF4-SRA positivity in the setting of VITT, after platelet count improvement using either IVIG or TPE, vascular interventions using argatroban can show favorable courses. Use of repeated IVIG or TPE before such interventions still needs to be defined.https://doi.org/10.1186/s12959-022-00398-8Vaccine-induced immune thrombotic thrombocytopeniaHeparin-induced thrombocytopeniaArterial thrombosisLimb ischemiaPerioperative care |
| spellingShingle | Guillaume Roberge Benoit Côté Anthony Calabrino Nathalie Gilbert Nathalie Gagnon Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases Thrombosis Journal Vaccine-induced immune thrombotic thrombocytopenia Heparin-induced thrombocytopenia Arterial thrombosis Limb ischemia Perioperative care |
| title | Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases |
| title_full | Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases |
| title_fullStr | Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases |
| title_full_unstemmed | Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases |
| title_short | Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases |
| title_sort | acute lower limb ischemia caused by vaccine induced immune thrombotic thrombocytopenia focus on perioperative considerations for 2 cases |
| topic | Vaccine-induced immune thrombotic thrombocytopenia Heparin-induced thrombocytopenia Arterial thrombosis Limb ischemia Perioperative care |
| url | https://doi.org/10.1186/s12959-022-00398-8 |
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