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The authors re-analyzed samples from patients with a history of vaccine-induced immune thrombotic thrombocytopenia (VITT) with positive antiplatelet factor 4 (PF4) antibodies. Of the 69 patients with VITT, 45 received a second dose of the mRNA COVID-19 vaccine and 14 received the third dose. A total of 11 patients had breakthrough COVID-19 infections with mild symptoms and had their PF4 antibodies re-analyzed at the time of recovery (2 weeks on average), showing no recurrence of PF4 antibodies, thrombocytopenia, or thrombosis.
VITT appears to be independent of re-vaccination, breakthrough infection, or re-exposure. This is markedly different from heparin-induced thrombocytopenia, which seems to be the closest pathogenic relative of VITT. When managing patients with VITT, clinicians should breathe easier as most episodes are one-time events.
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a prothrombotic adverse effect of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an important measure in the prevention of severe coronavirus disease 2019 (Covid-19). VITT is caused by platelet-activating antiplatelet factor 4 (PF4) antibodies of immunoglobulin G class that have been rarely induced by two adenovirus vector–based Covid-19 vaccines, ChAdOx1 nCoV-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson/Janssen).