高抗pf4抗体滴度在AZD1222疫苗诱导的血栓性血小板减少症病例中的长期持久性

L. Barcella, C. Ambaglio, Paolo Gritti, F. Schieppati, Varusca Brusegan, E. Sanga, M. Marchetti, Luca Lorini, A. Falanga
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摘要

腺病毒载体抗sars - cov -2疫苗接种后发生的一种综合征,以血小板减少、静脉血栓形成和循环抗pf4抗体为特征,称为疫苗诱导的免疫性血栓性血小板减少症(VITT)。缺乏关于该综合征长期病程的数据。我们的目的是报告VITT患者的临床和实验室特征,从诊断到21个月的随访。该患者在接种ChAdOx1 nCoV-19疫苗后发生与d -二聚体升高、低纤维蛋白原、血小板减少和抗pf4抗体阳性相关的脑静脉血栓形成。脑血栓形成需要血管重建手术和减压颅骨切除术。在地塞米松和抗凝治疗开始后,血小板计数恢复。然而,观察到持续高抗pf4抗体滴度,无血栓复发。关于抗pf4抗体的长期持久性,它们的临床意义,以及它们在指导治疗决策中的可能作用,我们知之甚少。在我们的患者中,我们决定继续抗凝治疗超过21个月,同时平行监测抗pf4抗体。
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Long-term persistence of high anti-PF4 antibodies titer in a challenging case of AZD1222 vaccine-induced thrombotic thrombocytopenia
A syndrome occurring after adenoviral vector anti-SARS-CoV-2 vaccination, characterized by thrombocytopenia, venous thrombosis, and circulating anti-PF4 antibodies, known as vaccine-induced immune thrombotic thrombocytopenia (VITT), is well described. Data on the long-term course of this syndrome are lacking. Our aim is to report the clinical and laboratory features of a patient with VITT from diagnosis and during 21 months of follow-up. Cerebral venous thrombosis associated with elevated D-dimer, low fibrinogen, thrombocytopenia, and anti-PF4 antibodies positivity occurred in this patient after ChAdOx1 nCoV-19 vaccination. Cerebral thrombosis required a revascularization procedure and decompressive craniectomy. Upon dexamethasone and anticoagulant treatment initiation, the platelet count recovered. However, a persistently high anti-PF4 antibody titer, without thrombosis recurrence, was observed. Little is known about the long-term persistence of anti-PF4 antibodies, their clinical significance, and their possible role in guiding therapeutic decisions. In our patient, we decided to continue anticoagulant treatment beyond 21 months with parallel anti-PF4 antibody monitoring.
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