Myocardial infarction after COVID-19 vaccination-casual or causal?
14 Apr 2021-Diabetes and Metabolic Syndrome: Clinical Research and Reviews (Diabetes Metab Syndr)-Vol. 15, Iss: 3, pp 1055-1056
About: This article is published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews.The article was published on 2021-04-14 and is currently open access. It has received 31 citations till now.
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TL;DR: In this paper , the authors present two cases of central retinal vein occlusion presenting immediately after receiving the second dose of the Covishield vaccine, although the causal relationship cannot be drawn, the ophthalmologist should be aware of this adverse reaction.
Abstract: Coronavirus disease 2019 (COVID-19) is known to cause thromboembolic episodes apart from acute respiratory distress syndrome (ARDS). With large vaccine drives all across the world, there are a few case reports on post-vaccine thrombotic events seen with the AZD1222, ChAdO × 1 vaccine. Here, we present two cases of central retinal vein occlusion presenting immediately after receiving the second dose of the Covishield vaccine. Although the causal relationship cannot be drawn, the ophthalmologist should be aware of this adverse reaction.
26 citations
11 Aug 2021
TL;DR: A case of ST elevation myocardial infarction reported post Coronavirus disease 2019 (COVID-19) vaccine was reported in this paper, however, it is premature to draw a link between COVID-2019 vaccine and myocardia.
Abstract: A case of ST elevation myocardial infarction reported post Coronavirus disease 2019 (COVID-19) vaccine. Probably premature to draw a link between COVID-19 vaccine and myocardial infarction.
24 citations
TL;DR: In this article, the authors evaluate the existing evidence of COVID-19 vaccinations on these special populations and to provide clues to guide vaccination decision making to balance the benefits and risks of vaccinations.
19 citations
TL;DR: In this article , a review of the reported adverse effects of COVID-19 vaccination was conducted and it was found that the incidence of all the reported cardiovascular events is very rare and the benefits of vaccination far outweigh the risk.
15 citations
TL;DR: 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 cardiovascularThrombotic events.
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.
14 citations
References
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TL;DR: Denmark has temporarily suspended use of the Oxford-AstraZeneca covid-19 vaccine as a precautionary move after reports of blood clots and one death.
Abstract: Denmark has temporarily suspended use of the Oxford-AstraZeneca covid-19 vaccine as a precautionary move after reports of blood clots and one death. However, the European Medicines Agency (EMA) and the UK’s regulatory body have said that there is no indication that vaccination is linked to thromboembolic events.
Eight other countries—Norway, Iceland, Austria, Estonia, Lithuania, Luxembourg, Italy, and Latvia—have also suspended use of AstraZeneca’s vaccine. The decisions are a further setback for Europe’s vaccination campaign, which has struggled to pick up speed, partly because of delays in delivering the AstraZeneca vaccine.
The Danish Health Authority said that one person in Denmark had died after receiving the AstraZeneca vaccine and that it would suspend the drug’s use for two weeks while the case was investigated. “It is important to point out that we have not terminated the use of the AstraZeneca vaccine—we are just pausing its use,” said the Danish Health Authority’s director, Soren Brostrom.
On 10 …
229 citations
TL;DR: Kounis syndrome has revealed that the same mediators released from the same inflammatory cells are present in acute coronary events of nonallergic etiology, and drugs, substances targeting the stem cell factor that is essential for mast cell development, proliferation, survival, adhesion and homing could emerge as novel therapeutic ways capable to prevent acute coronary and acute cerebrovascular events.
Abstract: Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with mast cell activation, such as allergies or hypersensitivity and anaphylactic or anaphylactoid insults that can involve other interrelated and interacting inflammatory cells behaving as a ‘ball of thread’. It is caused by inflammatory mediators such as neutral proteases including tryptase and chymase, arachidonic acid products, histamine, platelet activating factor and a variety of cytokines and chemokines released during the activation process. Platelets with FCeRI and FCeRII receptors also participate in the above cascade. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute the three reported variants of this syndrome. Kounis syndrome is a ubiquitus disease that represents a magnificent natural paradigm and nature’s own experiment, in a final trigger pathway implicated in cases of coronary artery spasm a...
174 citations
"Myocardial infarction after COVID-1..." refers background in this paper
...Fourthly, it can be vasospastic allergic myocardial infarction in response to vaccine, termed as Kounis syndrome [7,8]....
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TL;DR: This is the first reported case of DVT presenting as an adverse event post-SARS-CoV-2 vaccination, and the intense immunological response evoked by the second dose of vaccine could be a trigger for the thrombotic event described.
Abstract: Currently, the SARS-CoV-19 pandemic represents the leading global health emergency, and vaccines are the primary health strategy to eradicate this global challenge. In Europe, three vaccines have been approved by the European Medicines Agency (EMA), two based on mRNA technology, and one with an adenovirus vector [1]. Published data show high protective efficacy rates in the face of mostly mild-tomoderate and short-lasting adverse effects, mainly after the second dose [2–4]. Venous thromboembolic (VTE) complications have been consistently reported to be increased in SARS-CoV-2 infection, most probably as the results of a thrombophilic state secondary to inflammation and immunethrombosis [5]. On the other hand, no reports are available regarding a possible association between VTE and SARSCov-2 post-vaccine acute-phase reaction. Here we describe a case of distal deep vein thrombosis occurring immediately days after the second dose of mRNA vaccine. A 66-year-old woman received the first dose of mRNA Covid-19 vaccine (BNT162b2, Comirnaty, Pfizer/BioNTech) subcutaneously on January 4th, 2021, without any reported clinical problem; she was scheduled for the second dose on January 25th. Her medical history was unremarkable except for post-trauma left leg neuropathy. She never had previous thrombotic events; she had one successful delivery. Her body mass index was 23 kg/m2; she did not smoke or had no allergic problems; she intermittently took painkillers for the neuropathy. On January 26th, 24 h after the second vaccine dose, she received acetaminophen for persistent fever with chills, fatigue, malaise, and muscle pain. On January 27th, 48 h after the second vaccine dose, persistent fever was still present, and acute right calf pain appeared in the absence of trauma. On January 28th, she was admitted for evaluation at the emergency room because of persistent pain and inability to walk. Physical examination was unremarkable except for mild edema in the right calf. Blood tests (Blood count, INR, PTT, fibrinogen, renal and hepatic function) were normal, as notably was the D-dimer measurement. A Color-Doppler ultrasound scan revealed the presence of deep vein thrombosis involving the right peroneal vein and extending up to the popliteal vein, without signs of venous insufficiency. Thrombophilia screening was otherwise negative except for the presence of heterozygous FV Leiden mutation. The patient started apixaban 10 mg bid for 1 week, followed by 5 mg bid, with rapid symptoms resolution. To our knowledge, this is the first reported case of DVT presenting as an adverse event post-SARS-CoV-2 vaccination. Arguably, the intense immunological response evoked by the second dose of vaccine could be a trigger for the thrombotic event described, a mechanism recognized in many clinical conditions. No DVT cases have been reported on 21,720 persons receiving BNT162b2, suggesting that the DVT incidence may be lower than one case every 5889 (this figure representing the 95% upper boundary of confidence interval) [4]. No apparent correlation can be made with the presence of a mild thrombophilia mutation in this patient. In our district, the vaccination program started on January 2021 and involved only health workers, of whom 3010 received two doses on January 25th. This case notwithstanding, we may consider that DVT post-vaccination incidence may still be very low and within the expected incidence figure. A longer follow-up and a greater diffusion of SARS-CoV-2 vaccines in the population are needed * Alberto Tosetto alberto.tosetto@aulss8.veneto.it
113 citations
"Myocardial infarction after COVID-1..." refers background in this paper
...There is single case report of myocardial infarction (MI) after the Moderna vaccine [4] and deep vein thrombosis following second dose of Pfizer vaccine [5]....
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TL;DR: A review of the current state of knowledge of immediate and delayed allergic reactions in the currently available vaccines against COVID-19, together with the general and specific therapeutic considerations is presented in this paper.
112 citations
29 Mar 2021
TL;DR: The AZD1222 vaccine is associated with development of a prothrombotic disorder that clinically resembles heparin-induced thrombocytopenia but which shows a different serological profile.
Abstract:
Background. Vaccines are important for managing the COVID-19 pandemic caused by SARS-CoV-2. However, following widespread vaccination using a recombinant adenoviral vector encoding the spike protein antigen of SARS-CoV-2 (AZD1222, AstraZeneca), reports have emerged of some vaccine recipients developing unusual thrombotic events and thrombocytopenia. We investigated whether such patients could have a prothrombotic disorder caused by platelet-activating antibodies directed against platelet factor 4 (PF4), as is known to be caused by heparin and sometimes other environmental triggers.Methods. We summarized the clinical and laboratory features of 9 patients in Germany and Austria who developed thrombosis and thrombocytopenia events following AZD1222 vaccination. Serum from four patients was used to test for anti-PF4/heparin antibodies, both by immunoassay and by platelet activation assays performed in the presence of heparin, PF4, or both.Results. The 9 patients (8 female; median age, 36 [range, 22—49) presented with thrombosis beginning 4 to 16 days post-vaccination: 7 patients had cerebral venous thrombosis (CVT), 1 had pulmonary embolism, and 1 had splanchnic vein thrombosis and CVT; 4 patients died. None had received heparin prior to symptom onset. All four patients tested strongly positive for anti-PF4/heparin antibodies by immunoassay; all 4 patients tested strongly positive in the platelet activation assay in the presence of PF4 independently of heparin. Platelet activation was inhibited by high concentrations of heparin, Fc receptor-blocking monoclonal antibody, and intravenous immunoglobulin.Conclusions. The AZD1222 vaccine is associated with development of a prothrombotic disorder that clinically resembles heparin-induced thrombocytopenia but which shows a different serological profile.
53 citations
"Myocardial infarction after COVID-1..." refers background in this paper
...suggested vaccine induced prothrombotic immune thrombocytopenia, an entity similar to heparin induced thrombocytopenia as the reason behind thrombotic phenomenon post-vaccination [3]....
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