Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia

This correspondence describes therapeutic plasma exchange (TPE) as a potential treatment for vaccine-induced immune thrombotic thrombocytopenia (VITT) refractory to first-line therapy. Three patients developed severe thrombotic events 10 to 16 days after receiving the ChAdOx1 nCoV-19 vaccine, with elevated D-dimer levels and positive PF4 antibody tests via serotonin release assay. Despite initial management with non-heparin anticoagulation and intravenous immune globulin (IVIG), disease progression continued. Initiation of TPE led to clinical improvement in all three cases, including platelet recovery and stabilization of thrombotic events. One patient required rituximab and another underwent above-knee amputation but avoided further ischemic damage. The authors propose TPE as an escalation strategy for VITT unresponsive to standard care and call for further validation in larger cohorts.

This correspondence describes therapeutic plasma exchange (TPE) as a potential treatment for vaccine-induced immune thrombotic thrombocytopenia (VITT) refractory to first-line therapy. Three patients developed severe thrombotic events 10 to 16 days after receiving the ChAdOx1 nCoV-19 vaccine, with elevated D-dimer levels and positive PF4 antibody tests via serotonin release assay. Despite initial management with non-heparin anticoagulation and intravenous immune globulin (IVIG), disease progression continued. Initiation of TPE led to clinical improvement in all three cases, including platelet recovery and stabilization of thrombotic events. One patient required rituximab and another underwent above-knee amputation but avoided further ischemic damage. The authors propose TPE as an escalation strategy for VITT unresponsive to standard care and call for further validation in larger cohorts.