TY - JOUR
T1 - Immune thrombocytopenia and COVID-19 vaccination
T2 - Outcomes and comparisons to prepandemic patients
AU - Choi, Philip Young Ill
AU - Hsu, Danny
AU - Tran, Huyen Anh
AU - Tan, Chee Wee
AU - Enjeti, Anoop
AU - Chen, Vivien Mun Yee
AU - Merriman, Eileen
AU - Yong, Agnes S.M.
AU - Simpson, Jock
AU - Gardiner, Elizabeth
AU - Cherbuin, Nicolas
AU - Curnow, Jennifer
AU - Pepperell, Dominic
AU - Bird, Robert
N1 - Funding Information:
We would like to thank in-kind support from the Thrombosis and Haemostasis Society of Australia and New Zealand and all the clinicians who have collaborated with us to pool this national expertise—Agnes Yuen, Angeline Josiah, Beng Chong, Cecily Forsyth, Chris Ward, Kris Ma, David Bishop, Daniel Giles, Emily Blyth, Fernando Roncolato, Gianna Pastore, Jessie Zhao, Julianne Falconer, Kate Melville, Kathleen Crozier, Kim Cartwright, Lisa Clarke, Maple Huang, Michelle Spanevello, Richar Blennerhassett, Sharon Avery, Susan Maccallum, Tracey Batt, Vanessa Manitta, and Zoe Loh. We have no funding to declare. P.C. and R.B. conceived the study, collected data, and prepared the manuscript. N.C. provided expert epidemiologic advice and prepared the manuscript. All other authors (D.H. H.A.T. C.W.T. A.E. V.M.Y.C. E.M. A.Y. J.S. J.C. and D.P.) contributed to the design of the study, data collection, and manuscript preparation. P.C. prepared the first draft, data analysis, and final submission. P.C. has received speaking fees from Novartis, is a consultant with Sobi and Sanofi, and is on the advisory board for Janssen. R.B. has received speaking fees from Amgen and Novartis, is on the advisory board for Amgen and Novartis, and is a consultant with Sobi. D.H. has received speaking fees from Amgen and Novartis and is a consultant with Sobi. D.P. has provided consultancy with Sanofi. All other authors—H.A.T. C.W.T. A.E. V.M.Y.C. A.Y. E.M. J.S. E.G. N.C. and J.C.—do not have any conflicts of interest to declare. Human Rights Ethics Committee approval waived the need for informed patient consent to collect, analyse and disseminate this data. Funding information There is no funding to declare.
Publisher Copyright:
© 2022 The Authors
PY - 2023/3/11
Y1 - 2023/3/11
N2 - Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia. Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts. Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination. Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005). Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.
AB - Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. After index case fatalities, there was concern among patients both with and without a prior history of ITP in Australia. Objectives: To describe treatment outcomes of ITP after COVID-19 vaccination and compare relapsed vs historical pre-COVID-19 ITP cohorts. Methods: We collected ITP cases in Australia within 6 weeks of receiving any COVID-19 vaccination as part of primary vaccination (up to October 17, 2021). Second, we reviewed platelet charts in a historical ITP cohort to determine whether platelet variability was distinct from relapsed ITP after vaccination. Results: We report on 50 patients (37 de novo, 13 relapsed ITP) vaccinated from March 22, 2021, to October 17, 2021. Although there was 1 fatality, bleeding was otherwise mostly minor: (70% WHO bleeding grade <2). De novo ITP was more likely after AstraZeneca ChAdOx1 nCoV-19 (89%) than Pfizer BNT162b2 (11%). Most patients responded quickly (median, 4 days; complete response, 40 of 45 [89%]). In the historical cohort, only 6 of 47 patients exhibited platelet variability (>50% decrease and platelets <100 × 109/L), but median platelet nadir was significantly higher than vaccination relapse (27 vs 6 × 109/L, P =.005). Conclusion: ITP was more frequently reported after AstraZeneca ChAdOx1 nCoV-19 than Pfizer BNT162b2 vaccination. Standard ITP treatments remain highly effective for de novo and relapsed ITP (96%). Although thrombocytopenia can be severe after vaccination, bleeding is usually mild. Despite some sampling bias, our data do not support a change in treatment strategies for patients with ITP after vaccination.
KW - BNT162 vaccine
KW - ChAdOx1 nCov-19
KW - COVID-19 vaccines
KW - immune thrombocytopenia
KW - treatment outcome
KW - vaccination
UR - http://www.scopus.com/inward/record.url?scp=85149846234&partnerID=8YFLogxK
U2 - 10.1016/j.rpth.2022.100009
DO - 10.1016/j.rpth.2022.100009
M3 - Article
C2 - 36531670
AN - SCOPUS:85149846234
SN - 2475-0379
VL - 7
JO - Research and Practice in Thrombosis and Haemostasis
JF - Research and Practice in Thrombosis and Haemostasis
IS - 1
M1 - 100009
ER -
