Acute lower limb ischemia caused by vaccine-induced immune thrombotic thrombocytopenia: focus on perioperative considerations for 2 cases

Thrombosis Journal - Tập 20 - Trang 1-6 - 2022
Guillaume Roberge1, Benoit Côté2, Anthony Calabrino1, Nathalie Gilbert1, Nathalie Gagnon1
1Centre d’Excellence Des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Hôpital Saint-François d’Assise, Université Laval, Québec, Canada
2Department of General Internal Medicine, Centre Hospitalier Universitaire de Québec, Hôpital de L’Enfant-Jésus, Université Laval, Québec, Canada

Tóm tắt

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. 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. 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.

Tài liệu tham khảo

Greinacher A, Thiele T, Warkentin T, Weisser K, Kyrle P, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021;2092–101.

Schultz N, Sørvoll I, Michelsen A, Munthe L, Lund-Johansen F, Ahlen M, et al. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;2124–30.

Muir K, Kallam A, Koepsell S, Gundabolu K. Thrombotic Thrombocytopenia after Ad26.COV2.S Vaccination. N Engl J Med. 2021;1964–5.

Tiede A, Sachs U, Czwalinna A, Werwitzke S, Bikker R, Krauss J, et al. Prothrombotic immune thrombocytopenia after COVID-19 vaccination. Blood. 2021;350–3.

Scully M, Singh D, Lown R, Poles A, Solomon T, Levi M, et al. Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;2202–11.

Poudel DR, Ghimire S, Dhital R, Forman DA, Warkentin TE. Spontaneous HIT syndrome post-knee replacement surgery with delayed recovery of thrombocytopenia: a case report and literature review. Platelets. 2017;614–20.

Pavord S, Scully M, Hunt B, Lester W, Bagot C, Craven B, et al. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. N Engl J Med. 2021;1680–9.

Bourguignon A, Arnold D, Warkentin T, Smith J, Pannu T, Shrum J, et al. Adjunct Immune Globulin for Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021;720–8.

Pishko A, Lefler D, Gimotty P, Paydary K, Fardin S, Arepally G, et al. The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia. J Thromb Haemost. 2019;1956–65.

Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AAR. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood. 2015;1470–6.

Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. Am J Med. 1996;502–7.

Patriquin C, Laroche V, Selby R, Pendergrast J, Barth D, Côté B, et al. Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021;857–9.

Greinacher A, Farner B, Kroll H, Kohlmann T, Warkentin TE, Eichler P. Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis. A retrospective of 408 patients. Thromb Haemost. 2005;132–5.

Cuker A, Arepally GM, Chong BH, Cines DB, Greinacher A, Gruel Y, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018;3360–92.

The ISTH Releases Interim Guidance on Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) - International Society on Thrombosis and Haemostasis [Internet]. Available from: https://www.isth.org/news/news.asp?id=561406

Silver D, Kapsch DN, Tsoi EKM. Heparin-induced thrombocytopenia, thrombosis, and hemorrhage. Ann Surg. 1983;301–6.

Warkentin T. Heparin-induced thrombocytopenia and the anesthesiologist. Can J Anaesth. 2002;S36–49.

Warkentin T, Pai M, Cook R. Intraoperative anticoagulation and limb amputations in patients with immune heparin-induced thrombocytopenia who require vascular surgery. J Thromb Haemost. 2012;148–50.

Roberge G, Tritschler T, MacGillivray C, Dufresne L, Nagpal SK, Scarvelis D. Persisting autoimmune heparin-induced thrombocytopenia after elective abdominal aortic aneurysm repair: a case report. J Thromb Thrombolysis. 2020;674–7.

Onuoha C, Barton KD, Wong ECC, Raval JS, Rollins-Raval MA, Ipe TS, et al. Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin-induced thrombocytopenia: A systematic review. Transfusion. 2020;2714–36.

Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Onwuemene OA. A population-based analysis on the use of therapeutic plasma exchange and intravenous immunoglobulin in heparin-induced thrombocytopenia. Thromb Res. 2021;6–14.

Dougherty JA, Yarsley RL. Intravenous Immune Globulin (IVIG) for Treatment of Autoimmune Heparin-Induced Thrombocytopenia: A Systematic Review. Ann Pharmacother. 2021;198–215.

Warkentin TE, Climans TH, Morin P-A. Intravenous Immune Globulin to Prevent Heparin-Induced Thrombocytopenia. N Engl J Med. 2018;1845–8.

Warkentin T, Sheppard J, Chu F, Kapoor A, Crowther M, Gangji A. Plasma exchange to remove HIT antibodies: dissociation between enzyme-immunoassay and platelet activation test reactivities. Blood. 2015;195–8.

Jones M, Boisvert A, Landry J, Petrasek P. Limb ischemia and pulmonary artery thrombosis afer the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine: a case of vaccine-induced immune thrombotic thrombocytopenia. CMAJ. 2021;E906–10.

Nazy I, Sachs UJ, Arnold DM, McKenzie SE, Choi P, Althaus K, et al. Recommendations for the clinical and laboratory diagnosis of VITT against COVID-19: Communication from the ISTH SSC Subcommittee on Platelet Immunology. J Thromb Haemost. 2021;1585–8.

Hellwig TR, Peitz GJ, Gulseth MP. High-dose argatroban for treatment of heparin-induced thrombocytopenia with thrombosis: A case report and review of laboratory considerations. Am J Heal Pharm. 2012;490–5.

Cooper N, Ghanima W. Immune Thrombocytopenia. Solomon CG, editor. N Engl J Med. 2019;945–55.

Barlow A, Barlow B, Reinaker T, Harris J. Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia. Pharmacotherapy. 2019;837:53.

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Thrombosis Journal

Tập 20

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