The University Hospital

Studies on thrombosis after SARS-CoV-2 vaccination

University Hospital Tübingen investigates new diagnosis and treatment methods

The Covid-19 pandemic has resulted in significant morbidity and mortality worldwide. To combat the pandemic, vaccines are being administered worldwide that are highly effective but may be associated with minimal adverse side effects. More recently, the AstraZeneca vaccine against the SARS-CoV-2 virus has alarmed the public with concerns about the rare but serious development of thrombotic events. This rare syndrome is known as vaccine-induced immune thrombotic thrombocytopenia (VITT). Within the framework of several consecutive studies, a research team from the Center for Clinical Transfusion Medicine at the University Hospital Tübingen has now investigated the development, diagnosis and possible treatment methods of the rare disease.

So-called vaccine-induced immune thrombotic thrombocytopenia (VITT) is a newly defined syndrome that leads to clot formation in rare sites such as the cerebral or abdominal vessels and decreased platelet counts. Timely diagnosis of vaccine-induced thrombosis is critical to the success of treatment. Shortly after the syndrome became known, an international research team, including physicians from the University Hospital of Tübingen, succeeded in establishing the first guidelines for the detection, diagnosis and treatment of patients suffering from this rare vaccine complication. The results are published in the Journal of Thrombosis and Hemostasis. VITT requires immediate clinical recognition followed by confirmatory laboratory diagnosis using specialized tests that are performed at only a few centers. Under the medical direction of Professor Dr. Tamam Bakchoul, the Center for Clinical Transfusion Medicine (ZKT) in Tübingen established these tests in its laboratory and offers them to other hospitals and medical care centers.

Initial experience in the diagnosis and treatment of patients who developed thrombotic events after SARS-CoV-2 vaccination demonstrated how antibody-mediated platelet activation contributes to the development of VITT. In addition, further research indicated that platelet activation can be inhibited by immunoglobulin therapy, which may be important for the treatment of patients with VITT. For their report, Karina Althaus, M.D., and her team studied eight patients (5 female, 3 male) aged 24 to 53 years who developed VITT six to 20 days after SARS-CoV-2 vaccination. The results of the study have been published in the renowned journal Haematologica.

In a follow-up study involving five patients, Dr. Günalp Uzun and researchers from Prof. Bakchoul's group investigated the efficacy of immunoglobulin therapy in patients with VITT. 

This showed that immunoglobulin therapy together with anticoagulation (drug administration to inhibit blood clotting) can rapidly increase platelet counts and inhibit clot activation without posing an additional risk of cerebral hemorrhage. The results of the study are published in the well-known medical journal Blood. 

To prevent progression of the disease, the researchers from Tübingen conclude that the use of immunoglobulin therapy can be recommended as a treatment option for patients with VITT.

Title of original publication

Nazy I, Sachs UJ, Arnold DM, McKenzie SE, Choi P, Althaus K, Ahlen MT, Sharma R, Grace RF, Bakchoul T. 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 Jun;19(6):1585-1588. https://doi.org/10.1111/jth.15341 

Althaus K, Möller P, Uzun G, Singh A, Beck A, Bettag M, Bösmüller H, Guthoff M, Dorn F, Petzold GC, Henkes H, Heyne N, Jumaa H, Kreiser K, Limpach C, Luz B, Maschke M, Müller JA, Münch J, Nagel S, Pötzsch B, Müller J, Schlegel C, Viardot A, Bäzner H, Wolf M, Pelzl L, Warm V, Willinek WA, Steiner J, Schneiderhan-Marra N, Vollherbst D, Sachs UJ, Fend F, Bakchoul T. Antibody-mediated procoagulant platelets in SARS-CoV-2- vaccination associated immune thrombotic thrombocytopenia. Haematologica. 2021 May 20. https://doi.org/10.3324/haematol.2021.279000  

Uzun G, Althaus K, Singh A, Möller P, Zieman U, Mengel A, Rosenberger P, Guthoff M, Petzold GP, Müller J, Büchsel M, Feil K, Henkes H, Heyne N, Maschke M, Limpach C, Nagel S, Sachs UJ, Fend F, Bakchoul T. The use of intravenous immunoglobulin in the treatment of vaccine-induced immune thrombotic thrombocytopenia. Blood. In Press
https://pubmed.ncbi.nlm.nih.gov/34166507/

https://doi.org/10.1182/blood.2021012479