The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context
Summary: Background: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccinatio...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-11-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606523002122 |
| _version_ | 1797691932101574656 |
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| author | Huyen A. Tran Lucy Deng Nicholas Wood Philip Choi Sally Singleton Lisa Clarke Sarah Khanlari Isis Maitland-Scott Robert Bird Scott Brown Bavahuna Manoharan Chee Wee Tan Michael Gold Pravin Hissaria Shannon Melody Sanjeev D. Chunilal S Jim Buttery Hazel Clothier Nigel W. Crawford Linny Phuong Dominic Pepperell Paul Effler Claire Parker Nicola Carter Kristine Macartney Megan McStea Todd Miller Michael Nissen Claire Larter Elspeth Kay Vivien M. Chen |
| author_facet | Huyen A. Tran Lucy Deng Nicholas Wood Philip Choi Sally Singleton Lisa Clarke Sarah Khanlari Isis Maitland-Scott Robert Bird Scott Brown Bavahuna Manoharan Chee Wee Tan Michael Gold Pravin Hissaria Shannon Melody Sanjeev D. Chunilal S Jim Buttery Hazel Clothier Nigel W. Crawford Linny Phuong Dominic Pepperell Paul Effler Claire Parker Nicola Carter Kristine Macartney Megan McStea Todd Miller Michael Nissen Claire Larter Elspeth Kay Vivien M. Chen |
| author_sort | Huyen A. Tran |
| collection | DOAJ |
| description | Summary: Background: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods: In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings: A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55–74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation: TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding: Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305. |
| first_indexed | 2024-03-12T02:21:28Z |
| format | Article |
| id | doaj.art-b490b8c5f37644d5be090761f1ac13e2 |
| institution | Directory Open Access Journal |
| issn | 2666-6065 |
| language | English |
| last_indexed | 2024-03-12T02:21:28Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj.art-b490b8c5f37644d5be090761f1ac13e22023-09-06T04:53:18ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652023-11-0140100894The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in contextHuyen A. Tran0Lucy Deng1Nicholas Wood2Philip Choi3Sally Singleton4Lisa Clarke5Sarah Khanlari6Isis Maitland-Scott7Robert Bird8Scott Brown9Bavahuna Manoharan10Chee Wee Tan11Michael Gold12Pravin Hissaria13Shannon Melody14Sanjeev D. Chunilal S15Jim Buttery16Hazel Clothier17Nigel W. Crawford18Linny Phuong19Dominic Pepperell20Paul Effler21Claire Parker22Nicola Carter23Kristine Macartney24Megan McStea25Todd Miller26Michael Nissen27Claire Larter28Elspeth Kay29Vivien M. Chen30The Alfred Hospital, Melbourne, Victoria, Australia; Monash Medical Centre, Clayton, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Corresponding author. The Alfred Hospital, Melbourne, Victoria, Australia.National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, AustraliaNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, AustraliaThe Canberra Hospital, Canberra, Australian Capital Territory, Australia; The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, AustraliaACT Health Directorate, Canberra, Australian Capital Territory, AustraliaDepartment of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia; Transfusion Policy and Education, Australian Red Cross Lifeblood, Sydney, New South Wales, AustraliaNew South Wales Ministry of Health, St Leonards, New South Wales, AustraliaNew South Wales Ministry of Health, St Leonards, New South Wales, AustraliaDivision of Cancer Services, Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaQueensland Health, Brisbane, Queensland, AustraliaQueensland Health, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, AustraliaRoyal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia; SA Pathology, Adelaide, South Australia, Australia; University of Adelaide, South Australia, AustraliaDepartment of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia; Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, AustraliaRoyal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia; SA Pathology, Adelaide, South Australia, Australia; University of Adelaide, South Australia, AustraliaPublic Health Services, Tasmania Department of Health, Hobart, Tasmania, AustraliaMonash Medical Centre, Clayton, Victoria, Australia; Monash University, Melbourne, Victoria, AustraliaSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, Parkville, Victoria, AustraliaSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Health Analytics, Melbourne Children's Centre, Parkville, Victoria, AustraliaSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, Parkville, Victoria, AustraliaSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The Royal Children's Hospital Melbourne, Parkville, Victoria, AustraliaFiona Stanley Hospital, Perth, Western Australia, AustraliaWestern Australian Department of Health, Perth, Western Australia, AustraliaWestern Australian Department of Health, Perth, Western Australia, AustraliaNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, AustraliaNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, AustraliaAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, AustraliaAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, AustraliaFaculty of Medicine, University of Queensland, Brisbane, Queensland, AustraliaAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, AustraliaAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, AustraliaDepartment of Haematology and NSW Health Pathology, Concord Hospital Sydney, New South Wales, Australia; ANZAC Research Institute, Sydney Local Health District, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, AustraliaSummary: Background: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods: In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings: A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55–74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation: TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding: Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305.http://www.sciencedirect.com/science/article/pii/S2666606523002122ThrombosisThrombocytopeniaAdverse eventsVaccinationCOVID-19 |
| spellingShingle | Huyen A. Tran Lucy Deng Nicholas Wood Philip Choi Sally Singleton Lisa Clarke Sarah Khanlari Isis Maitland-Scott Robert Bird Scott Brown Bavahuna Manoharan Chee Wee Tan Michael Gold Pravin Hissaria Shannon Melody Sanjeev D. Chunilal S Jim Buttery Hazel Clothier Nigel W. Crawford Linny Phuong Dominic Pepperell Paul Effler Claire Parker Nicola Carter Kristine Macartney Megan McStea Todd Miller Michael Nissen Claire Larter Elspeth Kay Vivien M. Chen The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context The Lancet Regional Health. Western Pacific Thrombosis Thrombocytopenia Adverse events Vaccination COVID-19 |
| title | The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context |
| title_full | The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context |
| title_fullStr | The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context |
| title_full_unstemmed | The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context |
| title_short | The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based studyResearch in context |
| title_sort | clinicopathological features of thrombosis with thrombocytopenia syndrome following chadox1 s azd1222 vaccination and case outcomes in australia a population based studyresearch in context |
| topic | Thrombosis Thrombocytopenia Adverse events Vaccination COVID-19 |
| url | http://www.sciencedirect.com/science/article/pii/S2666606523002122 |
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