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COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST)- Lessons for India
Erum Khan1, Shriya Bavishi1, Arvind K Sharma2, Vijay K Sharma3, Vinay Goyal4
1 Department of Medicine, BJ Medical College and Civil Hospital, Ahmedabad, Gujarat, India
2 Department of Medicine, BJ Medical College and Civil Hospital; Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
3 Yong Loo Lin School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore
4 Department of Neurology, Medanta The Medicity, Gurugram, Haryana, India
Correspondence Address:
Arvind K Sharma,
Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/aian.aian_669_21
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The COVID-19 pandemic evolved rapidly, overwhelming health care systems around the world. The cost to life and socioeconomic burden prompted a search for new treatments and vaccines. Several collaborations developed and could deliver state-of-the-art vaccines with acceptable efficacy and safety in record time. Recently, vaccination with Oxford-AstraZeneca and Johnson and Johnson vaccines was halted due to the reported adverse effects of vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST). Although a detailed risk-benefit analysis led to their reinstitution, physicians across the world are still trying to understand the pathophysiology and mechanisms of these neurological adverse effects in order to better identify, diagnose, and treat them. One of the mechanisms that have been implicated is related to the adenovirus-based vector of these vaccines. COVISHIELD, which is the most widely administered vaccine in India, also shares the same vector. As India enters the next phase of vaccine distribution for younger adults, there are chances that such adverse effects may emerge. In this review, we analyze the temporary suspension of the administration of the vaccines due to VITT/CVST, summarize the existing guidelines about diagnosis and treatment of these neurological disorders as well as the need for increasing pharmacovigilance and awareness among physicians. Screening for potential risk factors, avoiding aggravating factors like dehydration, and providing choices in vaccinating the high-risk populations could help in avoiding these rare but potentially fatal adverse outcome.
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