PB0069 - Splanchnic vein thrombosis and Budd-Chiari syndrome after SARS-CoV-2 vaccination – incidence of VITT

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Mandy N. Lauw, MD PhD

Hematologist
Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
Rotterdam, Zuid-Holland, Netherlands

Co-Author(s)

RM

Raoel Maan

Fellow gastroenterology and hepatology
Department of Gastroenterology and Hepatology, Erasmus University Medical Center
Rotterdam, Zuid-Holland, Netherlands
Aurelie Plessier, MD

Hepatologist
Université de Paris, Centre de recherche sur l'inflammation, Inserm
Paris, Ile-de-France, France
LC

Louise China

Hepatologist
Institute of Liver and Digestive Health, University College London
London, England, United Kingdom
DP

David Patch

Hepatologist
Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust
London, England, United Kingdom
AB

Anna Baiges

Hepatologist
Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona
Barcelona, Catalonia, Spain
JG

Juan Carlos Garcia-Pagan

MD
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD. University of Barcelona, Barcelona. Spain
Barcelona, Catalonia, Spain
VH

Virginia Hernandez-Gea

Hepatologist
Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona
Barcelona, Catalonia, Spain
MH

Marie-Noelle Hilleret

Hepatologist
Service d'Hépato-Gastroentérologie, CHU Grenoble Alpes
Grenoble, Auvergne, France
ET

Eric Tjwa

Hepatologist
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen
Nijmegen, Gelderland, Netherlands
BG

Baptiste Giguet

Hepatologist
Liver disease department, CHU Rennes, Univ Rennes
Rennes, Bretagne, France
AH

Alexandra Heurgue

Hepatologist
Department of Hepato-Gastroenterology, CHU Reims
Reims, Champagne-Ardenne, France
IO

Isabelle Ollivier-Hourmand

Hepatologist
Department of hepatology and gastroenterology, University Hospital, Côte de Nacre, Caen
Caen, Basse-Normandie, France
SD

Sarwa Darwish Murad

Hepatologist
Department of Gastroenterology and Hepatology, Erasmus University Medical Center
Rotterdam, Zuid-Holland, Netherlands

Background: Several studies have been published on a rare side effect of severe venous thrombosis at unusual sites and thrombocytopenia after vaccination against SARS-CoV-2, referred to as vaccine-induced immune thrombocytopenia and thrombosis (VITT).

Aims: To identify new cases of acute splanchnic vein thrombosis (SVT) or Budd-Chiari Syndrome (BCS) who presented following SARS-CoV-2 vaccination in the Vascular Liver Disease Group (VALDIG) network, and to evaluate the incidence of VITT.

Methods: We conducted a prospective international cohort study between May 1st, 2021 and January 10th, 2022, on consecutive patients with acute SVT or BCS who presented within 6 weeks following any type or dose of SARS-CoV-2 vaccination. Anonymous data were collected including baseline characteristics, risk factors, treatment and survival. Cases were identified as definite VITT, probable VITT or possible VITT or unlikely VITT as defined by Pavord et al (NEJM 2021).

Results: 25 patients with acute (N=24) or recurrent (N=1) SVT or BCS were collected from 14 centers in 4 countries (after ChAdOx1 nCoV-19 N=11, BNT162b2 N=9, Ad26.COV2.S N=1, mRNA-1273 N=1). Median time after vaccination to symptoms was 10 days (2-40). Median age was 52.5 years (21-66), 52% were female. Three patients (12%) fulfilled criteria for definite VITT, 6 (24%) for probable VITT, 2 (8%) for possible VITT, 14 (56%) for unlikely VITT. Thrombosis was located in the portal vein (N=20), hepatic vein(s) (N=9), mesenteric vein (N=18) or splenic vein (N=9). Concomitant extra-abdominal thrombosis was seen in 5 patients (20%). Patients were treated with LMWH (60%), DOACs (24%) or VKA (40%). Six (2/3 with definite VITT) received IVIG. Thrombophilia was found in 5 patients and 3 had a myeloproliferative neoplasm.

Conclusion(s): 25 cases of acute SVT or BCS following SARS-CoV-2 vaccination were identified. Although definite VITT was rare (12%), no underlying disorder was identified in the majority of patients, contrary to ‘typical’ cases of SVT and BCS.