Natural history of PF4 antibodies in vaccine-induced immune thrombocytopenia and thrombosis.
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Authors
Boyce, Sara
Thomas, Will
Kanny, Angela
Davies, Claire
Pavord, Sue
Hermans, Joannes
Bart-Smith, Emily
Arnott, Sarah
Chudakou, Pavel
Calvert, Anthony
Singh, Deepak
Scully, Marie
Publication Date
2022-04-21Journal Title
Blood
ISSN
0006-4971
Publisher
American Society of Hematology
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Craven, B., Lester, W., Boyce, S., Thomas, W., Kanny, A., Davies, C., Pavord, S., et al. (2022). Natural history of PF4 antibodies in vaccine-induced immune thrombocytopenia and thrombosis.. Blood https://doi.org/10.1182/blood.2021014684
Abstract
The COVID-19 pandemic has resulted in the rapid development of a range of vaccines against SARS-CoV-2. Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare but life-threatening complication of primarily adenoviral-based vaccines associated with the presence of antibodies to a PF4/polyanion neoepitope and measured by using enzyme-linked immunosorbent assays. Presented are serial anti-PF4/polyanion antibody, platelet, and D-dimer measurements in a large cohort of patients and their relation to relapse. Overall, 51% of patients using the Stago assay had persistently positive anti-PF4/polyanion levels 100 days' postdiagnosis, whereas 94% of patients monitored by using the Immucor assay remain positive. The median duration of positivity of the PF4 assay is 87 days, with 72% of patients remaining positive after a median follow-up of 105 days. The use of plasma exchange seemed to reduce anti-PF4/polyanion levels and increase platelet counts in the acute setting more rapidly than other therapies. The rate of relapse in this study was 12.6%, with all relapsed cases exhibiting persistently positive PF4 antibodies and falling platelet counts. Only one patient had extension of their thrombosis. Overall, despite the persistence of PF4 antibodies in 72% of patients, the rate of relapse was low and did not seem to result in recrudescence of the aggressive clinical picture seen at index presentation. Monitoring of these patients in the UK cohort is ongoing and will aid in definition of the natural history of this novel condition.
Identifiers
35263420, PMC8912978
External DOI: https://doi.org/10.1182/blood.2021014684
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335955
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