{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:58:23Z","timestamp":1790773103707,"version":"4.1.0"},"reference-count":17,"publisher":"American Society of Hematology","issue":"4","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We report 5 cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis, splanchnic vein thrombosis, arterial cerebral thromboembolism, and thrombotic microangiopathy. All patients had thrombocytopenia and markedly elevated D-dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients, although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependent manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in 3 patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events.<\/jats:p>","DOI":"10.1182\/blood.2021011958","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T11:06:57Z","timestamp":1619608017000},"page":"350-353","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":147,"title":["Prothrombotic immune thrombocytopenia after COVID-19 vaccination"],"prefix":"10.1182","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3600-8536","authenticated-orcid":false,"given":"Andreas","family":"Tiede","sequence":"first","affiliation":[{"name":"Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich J.","family":"Sachs","sequence":"additional","affiliation":[{"name":"Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany;"},{"name":"Department of Thrombosis and Hemostasis, Giessen University Hospital, Giessen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Czwalinna","sequence":"additional","affiliation":[{"name":"Amedes MVZ WagnerStibbe Center for Laboratory Medicine, Hannover, Germany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Werwitzke","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4914-7049","authenticated-orcid":false,"given":"Rolf","family":"Bikker","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0675-9064","authenticated-orcid":false,"given":"Joachim K.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-1929","authenticated-orcid":false,"given":"Frank","family":"Donnerstag","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1157-8938","authenticated-orcid":false,"given":"Karin","family":"Wei\u00dfenborn","sequence":"additional","affiliation":[{"name":"Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7587-6187","authenticated-orcid":false,"given":"G\u00fcnter","family":"H\u00f6glinger","sequence":"additional","affiliation":[{"name":"Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3250-3177","authenticated-orcid":false,"given":"Benjamin","family":"Maasoumy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-4304","authenticated-orcid":false,"given":"Arnold","family":"Ganser","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","published-online":{"date-parts":[[2021,4,28]]},"reference":[{"issue":"7852","key":"2021072815240619100_B1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1038\/d41586-021-00785-7","article-title":"What scientists do and don\u2019t know about the Oxford-AstraZeneca COVID vaccine","volume":"592","author":"Mallapaty","year":"2021","journal-title":"Nature."},{"issue":"2","key":"2021072815240619100_B2","doi-asserted-by":"crossref","first-page":"103093","DOI":"10.1016\/j.transci.2021.103093","article-title":"Immunotherapy for COVID-19: evolving treatment of viral infection and associated adverse immunological reactions","volume":"60","author":"Putter","year":"2021","journal-title":"Transfus Apheresis Sci."},{"issue":"10269","key":"2021072815240619100_B3","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0140-6736(20)32661-1","article-title":"Oxford COVID Vaccine Trial Group. 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