Multiple sites of thrombosis without thrombocytopenia and COVID-19 vaccine: Correspondence

Abstract

Background: An adverse effect of COVID-19 vaccine is possible and it is necessary to monitor it. Methods and results: This is a correspondence on the published article on multiple sites of thrombosis without thrombocytopenia and COVID-19 vaccine. Conclusion: Confounding factors regarding thrombosis without thrombocytopenia and COVID-19 vaccine are discussed.

Dear Editor, we would like to share ideas on the publication “Multiple sites of thrombosis without thrombocytopenia after a second dose of Pfizer-BioNTech COVID-19 vaccine.¹” Scendoni et al.¹ described a 75-year-old woman in good health who experienced cerebral venous thrombosis, deep venous thrombosis, and bilateral pulmonary emboli after getting a second dose of the Pfizer-BioNTech COVID-19 vaccine. Although COVID-19 immunization is the most significant technique for containing the pandemic, Scendoni et al. observed that pharmacovigilance is critical for detecting potential multisystem thrombotic events, even with mRNA vaccines.

The purpose of this correspondence is to discuss a published study on several sites of thrombosis without thrombocytopenia and the COVID-19 vaccine from a scientific perspective. Despite its advantages, the COVID-19 vaccine may be dangerous, which worries us all. Due to a lack of information on the health and immunological status of vaccination recipients before inoculation, determining the precise source of the clinical issue is challenging. A clinical comorbidity may be the source of the problem detected during the COVID-19 vaccination.² Due to the lack of an adequate accurate record of a person’s health or immune condition before getting COVID-19 immunization, it is now too early to assess any potential harmful repercussions. It is important to stress the need for caution when evaluating the vaccinations recommended and carried out to combat COVID-19, especially in light of their potential influence on public opinion.

Before linking an incident with the vaccine, Scendoni et al. made it clear that a thorough history of the patient’s comorbidities and vaccinations was required.¹ Scendoni et al. provided some suggestions on how the diagnosis should be made in these circumstances, making it apparent that the patient’s immunization history must be taken into consideration even though there was no formal confirmation of the diagnosis. It is important to also talk about how reliable a person’s immunization history is.

Additionally, it’s important to consider any potential asymptotic COVID-19 infections in the past. When talking about the effects of vaccination, it is important to rule out the asymptomatic COVID-19 because it is not unusual.³ The primary objective of Scendoni et al.’s manuscript might be to present a clinical case objectively in order to gather whatever evidence there may be of the side effects of the vaccine; in fact, Scendoni et al. stated in their conclusions: “To fully and accurately communicate with patients about potential side effects, it is essential to conduct ongoing pharmacovigilance. When a patient exhibits thrombosis symptoms and there are no other clear risk factors, it is essential to get their vaccination history.¹” But for every incident, a thorough and exhaustive inquiry is required. The routine monitoring is frequently based on a formal record or checklist in many contexts, and it may not be enough to conduct an in-depth study.

Given that no further risk factors were mentioned, Scendoni et al. can assert that the vaccine had a temporal association with the condition. However, as was already indicated, there should be some concern expressed over the patient’s past. The data might be stronger if there were thorough laboratory tests, including baseline thrombohemostatic, genetic, and past COVID-19. When a patient experiences simultaneous thrombosis at more than one site within a short period of time, it is important to consider other possible explanations for the incident. A vasculitis, perhaps? What caused this? Was the trigger a vaccine? These inquiries must be made clear. However, the possibility of another explanation for vaccine-associated thrombosis has already been brought up by other writers and needs to be looked into. As a good example, Mahgoub et al. have already mentioned the possibility of another etiology for vaccine-associated thrombosis. A case of a man who abruptly acquired right lower extremity (RLE) pain and swelling that happened between two doses of COVID-19 vaccination was previously described by Mahgoub et al.⁴ He nevertheless received his second dosage of the mRNA-1273 COVID-19 vaccination. Investigations revealed a significant acute pulmonary embolism and widespread acute deep vein thrombosis.⁴ An older patient who had no prior medical history and had passed the pre-vaccination health screening experienced a sudden thrombohemostatic attack while waiting to receive the first dose of the COVID-19 vaccine in a vaccination center.⁵ This situation is similar to one that was reported from a Southeast Asian country. This is an obvious illustration of a circumstance that might be overlooked or misinterpreted if it happened a little later. Last but not least, it was asserted that “not all post-COVID-19 immunization thrombotic events are caused by the vaccination.”

ORCID iD

Rujittika Mungunpuntipantip https://orcid.org/0000-0003-0078-7897