![]() ![]() This syndrome has been termed “vaccine-induced prothrombotic immune thrombocytopenia (VIPIT)” or “vaccine-induced immune thrombotic thrombocytopenia (VITT),” and “thrombosis with thrombocytopenia syndrome (TTS)” in communications from the CDC and FDA. Comprehensive clinical and laboratory characteristics of VITT have been reported in retrospective series and a large prospective cohort. This announcement came on the heels of the initial reports of similar events in individuals receiving the CHaDOx1 nCov-19 AstraZeneca (AZ) vaccine outside the United States. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) suggested pausing administration of the Johnson & Johnson (JJ) vaccine to allow investigation of several cases of severe thrombosis with thrombocytopenia occurring post-vaccination. Use of a non-heparin anticoagulant may be indicated if patient is 4 to 42 days post–vaccine with all other facets of the syndrome pending PF4 ELISA testing and additional CBCs. *A patient who presents with thrombosis and a normal platelet count post-vaccination might be in an early stage of VITT. Continued assessment for development of thrombocytopenia/VITT is required. #To date, VITT appears far more likely following AstraZeneca/Johnson and Johnson adenoviral vaccines than Moderna/Pfizer mRNA vaccines. Knowledge about VITT continues to evolve, and updates will be made as new data become available. Consider referral to tertiary care center if VITT is confirmed.Avoid platelet transfusions unless other treatments have been initiated AND life-threatening bleeding or imminent surgery.If thrombocytopenia but no thrombosis and negative PF4 ELISA: likely ITP (see Q4).If thrombocytopenia and very high D-Dimer in absence of known thrombosis, particularly in the presence of severe headache, check PF4 ELISA, and consider treatment (see Q2).If PF4 ELISA returns negative and there is no thrombocytopenia, VITTis ruled out treat as standard venous thromboembolism. Confirmed thrombosis AND at least one of the following.Initiate therapy with intravenous immunoglobin and nonheparin anticoagulation pending PF4 ELISA results if:. ![]() PF4-ELISA (HIT assay) draw blood prior to any therapies.Imaging for thrombosis based on signs/symptoms. ![]()
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