Blood Research

Clinical and laboratory characteristics of patients with vaccine-induced immune thrombotic thrombocytopenia (VITT).

Patient No. Age, years Sex Symptom onset (N of days after vaccination) Symptoms CVT Splan-chnic vein throm-bosisa) Pulm-onary embo-lism Other throm-bosis or hemorr-hage Platelet initial (per mL) Platelet nadir (per mL) D-dimer, peak (mg/L) INR peak PTT peak (sec) Fibrino-gen nadir (mg/dL) PF4–heparin ELISA (optical density) Heparin treatment Other medical conditions Outcome
Korean 1 33 M 11 Headache, seizure Yes No No Cerebral hemorrhage 77,000 65,000 >20 1.01 35.7 197.9 3.10 No ACL-Ab Full recovery
Korean 2 33 M 8 Headache, hemiparesis, drowsiness Yes No No Cerebral hemorrhage 14,000 10,000 >35.2 1.51 60.7 77 0.72 No No Fatal
Ref 1-1 NA NA 5 Chills, fever, nausea, and epigastric discomfort Yes Yes Yes Aortoiliac artery thrombosis NA 13,000 142 1.4 41.6 78 3.16 Yes No Fatal
Ref 1-2 NA NA 6 NA No No Yes No NA 107,000 1.8 1.12 29 568 3.08 LMWHe) No Recovering
Ref 1-3 NA NA 9 NA Yes No No No NA 60,000 13 NA NA NA 3.5 Unknown No Unknown
Ref 1-4 NA NA 7 NA Yes No No No NA 9,000 NA 1.66 46.6 NA 3.4 Yes CND Fatal
Ref 1-5 NA NA 13 NA Yes Yes Yes Right intra-ventricular, iliofemoral vein, IVC thrombi NA 23,000 NA 1.25 64.8 173 1.2 Yes VWD-I; FVL; ACL-Abs Recovering
Ref 1-6 NA NA 7 NA Yes No No No NA 75,000 2.6 1.05 23 NA NA Unknown No Recovering
Ref 1-7 NA NA 8 NA Yes No No No NA 29,000 >33.0 1.34 45 210 NA Yes No Recovering
Ref 1-8 NA NA 8 NA Yes No No Widespread microvascular thrombi (brain, lungs, and kidneys)d) NA 16,000 NA NA NA NA 2.02 No No Fatal
Ref 1-9 NA NA 16 NA Yes No No Multiple organ thrombid) NA 13,000 21 1.7 46.1 40 3.51 No No Fatal
Ref 1-10 NA NA 11 NA Yes Yes No No NA 8,000 >35.0 NA NA 80 2.35 No No Fatal
Ref 1-11 NA NA 12b) NA Pendingc) No No Cerebral hemorrhagec) NA NA NA NA NA NA 2.16 No Unknown Fatal
Ref 4-1 37 F 8 Fever, headache, visual disturbances Yes No No No NA 22,000 >35 1.2 25 210 3.7 Initial low dose of LMWH NA Fatal
Ref 4-2 42 F 10 Headache, drowsiness Yes No No No NA 14,000 >35 1 31 80 35.93.4 Reduced dose of LMWH NA Fatal
Ref 4-3 32 M 7 Back pain No Yes No Azygos vein, hemiazygos vein, and several basivertebral veins’ thrombi NA 10,000 >35 1.1 25 230 3.6 Reduced dose of LMWH NA Full recovery
Ref 4-4 39 F 10 Headache, abdominal pain Yes No No No NA 70,000 13 1.3 25 120 3.8 Reduced dose of LMWH NA Full recovery
Ref 4-5 54 F 7 Headache, hemiparesis Yes No No No NA 19,000 >35 1.1 29 120 2.9 Heparin (5,000 IU) NA Fatal
Ref 5-1 30 F 13 NA Yes Yes Yes Ischemic bowel with infarction 27,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-2 55 F 6 NA No Yes No Acute aortic thrombosis and cerebral hemorrhage 11,000 NA NA NA NA NA Pos NA NA Died
Ref 5-3 26 F 12 NA Yes No No No 64,000 NA NA NA NA NA 2.45 NA NA Survived
Ref 5-4 52 F 10 NA Yesd) No Yesd) Cerebral hemorrhaged) 31,000 NA NA NA NA NA 2.26 NA NA Died
Ref 5-5 38 M 14 NA No No Yes No 16,000 NA NA NA NA NA 2.84 NA NA Died
Ref 5-6 49 F 15 NA Yes No Yes Cerebral hemorrhage 14,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-7 25 M 9 NA Yes No No No 19,000 NA NA NA NA NA Pos NA NA Died
Ref 5-8 32 M 19 NA Yes No No No 87,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-9 35 F 9 NA Yes No No No 65,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-10 77 M 8 NA No No Yes No NA NA NA NA NA NA Pos NA NA Survived
Ref 5-11 66 M 12 NA No No No Deep vein thrombosis, adrenal hemorrhage 34,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-12 34 M 14 NA Yes No No No 23,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-13 54 M 10 NA No Yes No Myocardial infarction 71,000 NA NA NA NA NA 0.76 NA NA Died
Ref 5-14 71 F 14 NA No No No Hemorrhagic symptoms only 17,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-15 22 F 10 NA Yes No No Cerebral hemorrhage 100,000 NA NA NA NA NA 1.4 NA NA Died
Ref 5-16 39 F 10 NA No No No Cerebral infarction 57,000 NA NA NA NA NA 1.4 NA NA Survived
Ref 5-17 70 F 17 NA No No Yes Deep vein thrombosis 28,000 NA NA NA NA NA Pos NA NA Survived
Ref 5-18 21 M 10 NA No No No Cerebral infarction 113,000 NA NA NA NA NA 2.8 NA NA Survived
Ref 5-19 46 F 14 NA Yes No No No 7,000 NA NA NA NA NA >3.00 NA NA Survived
Ref 5-20 32 F 12 NA Yes No No No 98,000 NA NA NA NA NA 2.17 NA NA Died
Ref 5-21 48 M 14 NA Yes No No No 16,000 NA NA NA NA NA 2.45 NA NA Survived
Ref 5-22 49 F 24 NA No No Yes No 61,000 NA NA NA NA NA >3.00 NA NA Survived
Ref 6-1 72 F 7 Leg pain, claudication No No No Peripheral artery thromboses 36,000 39,000 >20 NA NA 237 2.70 Yes NA Full recovery
Ref 6-2 63 M 18 Leg clamping No No Yes Peripheral artery thromboses, deep vein thrombosis 36,000 26,000 >10 1.3 NA 140 1.78 Yes NA Full recovery
Ref 6-3 69 M 12 Headache, confusion Yes Yes Yes Cerebral infarction, internal jugular vein thrombosis 35,000 29,000 3.35 1.4 NA 210 2.69 No NA Recovering

a)Splanchnic-vein thrombosis indicates thrombosis of the portal, mesenteric, splenic, or hepatic veins.

b)The day when the body of the deceased was found.

c)Brain neuropathological results were pending at time of this report; CVT had not been ruled out.

d)These were the postmortem findings.

e)Treatment with low-molecular-weight heparin was associated with clinical improvement and increasing platelet counts (107,000 to 132,000 over 3 days). The patient’s drug was then switched to a direct oral anticoagulant when the ELISA showed positive results for antibodies against PF4–heparin, with further clinical and platelet-count recovery.

Abbreviations: ACL-Abs, anticardiolipinantibodies; CVT, cerebral venous (sinus) thrombosis of the cortical vein; ELISA, enzyme-linked immunosorbent assay; F, female; FVL, factor V Leiden; INR,

international normalized ratio; IVC, inferior vena cava; LMWH, low-molecular-weight heparin; M, male; NA, not available; PF4, platelet factor 4; Pos, positive; PTT, partial thromboplastin time; VWD-I,

type 1 von Willebrand disease.
Blood Res 2021;56:129~133 https://doi.org/10.5045/br.2021.2021126
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