A Review on Suggested Mechanisms in Thrombocytopenia and Thrombosis Following ChAdOx۱ nCoV-۱۹ Vaccination

Publish Year: 1400
نوع سند: مقاله ژورنالی
زبان: English
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JR_REMJ-9-4_001

تاریخ نمایه سازی: 20 دی 1402

Abstract:

Background: ChAdOx۱ nCov-۱۹ vaccine is a viral vector-based vaccine with desirable protection (about ۷۰.۴%, two weeks after the second dose). Few reports were released on thrombocytopenia associated with thrombotic events shortly after the ChAdOx۱ nCov-۱۹ vaccination. However, the exact pathophysiologic mechanism of this vaccineinduced thrombotic complication has not yet been elucidated. Vaccine-induced thrombotic thrombocytopenia syndrome (VITTS) is associated with detecting anti-platelet factor ۴ (PF۴) antibodies that are not yet linked to previous exposure to heparin. Materials and Methods: In the current review, based on relevantly reported cases, possible mechanisms are suggested on the relationship between the anti-platelet factor ۴ (anti-PF۴) antibody assays, previous exposure to heparin, and the involved mechanisms of post-vaccination thrombocytopenia and thrombotic events, which might help the experts for selecting the appropriate therapeutic measures. Results: Possibly involved mechanisms in VITTS after ChAdOx۱ nCoV-۱۹ vaccination include binding of anti-PF۴ antibodies to heparin/PF۴ complex or receptor-binding domain (RBD) protein-PF۴ complex. Another mechanism could be the binding of anti-RBD antibodies to the RBD protein-PF۴ complex. Finally, anti-RBD or anti-PF۴ antibodies may bind to the heparin-RBD protein-PF۴ complex. The binding of either of the mentioned antibodies to these complexes via the Fc/angiotensin-converting enzyme ۲ receptors can cause activation/removal of platelets leading to thrombocytopenia and thrombosis. Conclusion: The suggested mechanisms in this article provide a relationship between the results of anti-PF۴ antibody assays, previous exposure to heparin, and the involved mechanisms of post-vaccination thrombocytopenia and thrombotic events, which might help the experts in selecting the therapeutic measures.

Authors

Negar Mottaghi Dastgerdi

Department of Pharmaceutics, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran (Email: Faghihi.h@iums.ac.ir; Homafaghihipharm@gmail.com; ORCID: ۰۰۰۰-۰۰۰۳-۱۵۰۵-۴۹۳۶)

Homa Faghihi

Department of Pharmacognosy and Pharmaceutical Biotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran (Email: Mottaghi.n@iums.ac.ir, Mottaghi.negar@gmail.com; ORCID: ۰۰۰۰-۰۰۰۱-۸۳۸۶-۷۷۴X)

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