Abstract
The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.
Highlights
Since the beginning of the SARS-CoV-2 pandemic, and the consequent coronavirus disease 2019 (COVID-19), up to date (6 February 2022), more than 394 million cases and over 5.7 million deaths have been documented in the world [1], with devastating socio-economic, physical, and psychological consequences for communities
This paper aims to explore the complex relationships between COVID-19, its vaccines, and thrombotic diseases
Thrombocytopenia was reported in 107/187 CVST cases (57%, 95% CI 50–64%) in the ChAdOx1 group, in none in the messenger RNA (mRNA) vaccine group (0%, 95% CI 0–13%), and in 7/100 (7%, 95% CI 3–14%) in a pre-COVID-19 group with CVST
Summary
Since the beginning of the SARS-CoV-2 pandemic, and the consequent coronavirus disease 2019 (COVID-19), up to date (6 February 2022), more than 394 million cases and over 5.7 million deaths have been documented in the world [1], with devastating socio-economic, physical, and psychological consequences for communities. The pathophysiology of SARSCoV-2 infection displays the predominance of hyperinflammation and immune dysregulation (cytokine release syndrome) in inducing multiorgan damage, predisposing patients to thrombotic and thromboembolic events due to endothelial cell activation and injury, platelet activation, and hypercoagulability [2]. Vaccines are the primary modality to prevent the disease from spreading. In 2020, an international race for developing vaccines against SARS-CoV-2 started [3]. Like COVID-19, even the vaccines employed for its prevention have been associated with unexpected thrombotic events. This paper aims to explore the complex relationships between COVID-19, its vaccines, and thrombotic diseases. Because of the low level of available evidence, and the continuous evolution of knowledge in this field, this is an interim document, based only on expert opinion consensus
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