E-Book

E-Book 3rd Congress

  • Thrombosis with thrombocytopenia syndrome caused by Covid-19 vaccine
  • Mahsa Taheri,1,* Mobina Nakhaei Shamahmood,2 Younes Sadeghi-Bojd,3
    1. Student Research Committee, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran.
    2. Student Research Committee, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran.
    3. Student Research Committee, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran


  • Introduction: The common reported adverse effects of COVID-19 vaccination consist of the injection site’s local reaction followed by several non-specific flu-like symptoms. However, recent reports of thrombosis with thrombocytopenia syndrome (TTS) associated with adenovirus vector vaccines have raised concern. Objective: This is narrative review to investigate TTS after the Covid-19 vaccine.
  • Methods: Studies of TTS after ChAdOx1 nCoV-19 or Ad26.COV2 vaccine were searched in PubMed, Scopus, Embase and Web of Science databases until August 2022. Summary effects between studies were observed regarding incidence, presentation, site of thrombosis, diagnostic findings, and clinical outcomes.
  • Results: TTS, also known as vaccine-induced immune thrombotic thrombocytopenia, is a reaction associated with exposure to the ChAdOx1 nCoV-19 and Ad26.COV2 vaccine, which may result in thrombocytopenia and thrombotic events. There are several case series of patients diagnosed with TTS, but the overall incidence is rare. TTS is characterized by exposure to one of the aforementioned vaccines 4–30 days prior to presentation, followed by thrombosis, mild-to-severe thrombocytopenia, and a positive platelet factor-4 (PF4)-heparin enzyme-linked immunosorbent assay (ELISA). Thrombosis typically involves atypical locations, including cerebral venous thrombosis and splanchnic vein thrombosis. Evaluation should include complete blood count, peripheral smear, D-dimer, fibrinogen, coagulation panel, renal and liver function, and electrolytes, as well as PF4-heparin ELISA if available. Consultation with hematology is recommended if suspected or confirmed. Treatment may include intravenous immunoglobulin and anticoagulation, while avoiding heparin based agents and platelet transfusion.
  • Conclusion: Health care providers should be familiar with the clinical presentations, pathophysiology, diagnostic criteria, and management consideration of TTS. Early diagnosis and quick initiation of the treatment may help to provide patients with a more favorable outcome.
  • Keywords: TTS, Covid-19, Vaccine.