Comparison of vaccine-induced thrombotic events between ChAdOx1 nCoV-19 and Ad26.COV.2.S vaccines
Graphical abstract
Introduction
Reports of rare thrombotic events such as cerebral venous thromboses (CVT) have been accumulating after COVID-19 vaccination [[1], [2], [3], [4], [5]]. Severe vaccine-induced thrombotic thrombocytopenia (VITT) following vaccine administration was initially reported after ChAdOx1 nCoV-19 vaccination (Astra-Zeneca) [[1], [2], [3], [4][1], [2], [3], [4][1], [2], [3], [4]], causing the European Medicine Agency (EMA) to issue a report on March 18, 2021 [6]. In the meantime, reports of CVT after another adenoviral vector-based vaccine, the Ad26.COV.2.S vaccine (Janssen/Johnson & Johnson), resulted in the US Food and Drug Administration (FDA) recommending a pause in the use of the Ad26.COV.2.S vaccine as well [7]. Although the clinical course of VITT has been postulated to be similar to autoimmune heparin-induced thrombocytopenia [1,2,5], the exact pathogenesis of VITT has not been fully elucidated, nor whether there are any differences in VITT events after the two adenoviral vector-based vaccines. Therefore, this study aimed to perform a rapid review to compare the clinical presentations of CVT cases between Ad26.COV.2.S and ChAdOx1 nCoV-19 vaccines.
Section snippets
Study design and data source
We conducted a rapid review to capture case reports of VITT after adenoviral vector-based COVID vaccine administration. We searched PubMed ePubs, Scopus, Embase, and Web of Science databases to include articles published up to April 28, 2021, and related to COVID-19 vaccine-associated CVT after adenoviral vector-based COVID-19 vaccine administration. Case series with more than five cases were considered. We only included cases with CVT documented by clinical and radiologic findings after
Results
Demographic and clinical characteristics of 40 patients (ChAdOx1 nCoV-19, n = 28; Ad26.COV.2.S, n = 12) are shown in Table 1 and Supplementary Table S1. Patients who received the Ad26.COV.2.S vaccine tended to have clinical manifestations later than those administered ChAdOx1 nCoV-19, with a median of 16 days post-vaccination compared to 10 days (p = 0.004). D-dimer levels were significantly lower in the Ad26.COV.2.S group (16.3 vs. 74.2 times the upper limit of normal, p = 0.036), and aPTT
Discussion
The current study is the first to directly compare CVT profiles after COVID-19 vaccine administration between the two adenoviral vector-based vaccines, Ad26.COV.2.S and ChAdOx1 nCoV-19. Although the main presenting symptoms were similar, with the majority reporting headaches and neurologic manifestations, patients who received Ad26.COV.2.S tended to present CVT later, with a median time to admission of 16 days post-vaccination compared to 10 days after ChAdOx1 nCoV-19. Therefore, it is
Conclusions
This study found that CVT after Ad26.COV.2.S vaccination presents later with similar symptoms compared to CVT after administration of ChAdOx1 nCoV-19, albeit with more thrombosis and intracerebral hemorrhage, lower D-dimer and aPTT levels but similar mortality. Understanding different characteristics between vaccines could help guide future clinical management of VITT.
Author statement
Jimin Hwang: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing. Se Bee Lee: Data curation, Writing – original draft, Writing – review & editing. Seung Won Lee: Writing – original draft, Writing – review & editing. Min Ho Lee: Writing – original draft, Writing – review & editing. Ai Koyanagi: Writing – original draft, Writing – review & editing. Louis Jacob: Writing – original draft, Writing – review & editing. Kalthoum Tizaoui: Writing – original draft,
Funding statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
Declaration of competing interest
None.
Acknowledgments
We thank Elena Dragioti and Joaquim Radua for their valuable discussions and feedback.
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