英国におけるCOVID-19ワクチン接種後の脳静脈血栓症:多センターコホート研究
Richard J Perry1, Arina Tamborska2, Bhagteshwar Singh3
1Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.
Lancet (London, England)
|August 9, 2021
まとめ
ワクチンによる免疫性血栓性血栓減少症 (VITT) は重度の脳静脈血栓症を引き起こす. 非ヘパリン抗凝固剤と免疫グロブリンによる早期治療は,VITT患者のアウトカムを改善する可能性があります.
科学分野:
- 神経学
- 免疫学
- 血液学
背景:
- ワクチンによる免疫性血栓性血栓縮小症 (VITT) は,稀だが深刻なCOVID-19ワクチン接種の副作用である.
- 脳静脈血栓症 (CVT) は,VITTの最も一般的な症状です.
- VITT患者のCVTの詳細な特徴と,VITT以外のCVT症例との比較が必要である.
研究 の 目的:
- ワクチン接種後のCVTの臨床的および放射線学的特徴を記録する.
- VITTに関連するCVTとVITT以外のCVTの成果を比較する.
- 特定の治療がVITTの結果に与える影響を評価する.
主な方法:
- COVID-19ワクチン接種後にCVTを受けた患者のマルチセンターコホート研究.
- データ収集には,臨床的,実験的 (抗PF4抗体を含む) および放射線学的発見が含まれていた.
- 低血小板数とD- ダイマー値上昇によって定義されたVITT症例; 修正ランキンスコアを使用して評価されたアウトカム.
主要な成果:
- 主に若い患者で,VITTに関連したCVTは95例のうち70例で発生しました.
- VITT患者は,VITTでない患者 (16%) に比べて,より広範な血栓形成と死亡率または依存度が高かった.
- 非ヘパリン抗凝固剤と静脈内免疫グロブリン治療は,VITT患者で改善された結果と関連していました.
結論:
- VITTに関連したCVTは,VITT以外のCVTと比較して,より悪い結果を持つ重篤な状態です.
- 非ヘパリン抗凝固剤と免疫グロブリン療法では,VITTの改善が期待されています.
- VITTに関連するCVTの診断基準を改訂し,より多くの患者を対象にすることを提案しています.
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