COVID-19 vaccination in patients with immune thrombocytopenia

Chantal Visser, Maurice Swinkels, Erik D. van Werkhoven, F. Nanne Croles, Heike S. Noordzij-Nooteboom, Matthijs Eefting, Suzanne M. Last-Koopmans, Cecile Idink, Peter E. Westerweel, Bart Santbergen, Pieter A. Jobse, Fazil Baboe, RECOVAC-IR Consortium, Peter A.W. te Boekhorst, Frank W.G. Leebeek, Mark David Levin, Marieke J.H.A. Kruip, A. J. Gerard Jansen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

35 Citations (Scopus)
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Immune thrombocytopenia (ITP) is an acquired autoimmune disorder that is characterized by low platelet count and increased bleeding risk. COVID-19 vaccination has been described as a risk factor for de novo ITP, but the effects of COVID-19 vaccination in patients with ITP are unknown. We aimed to investigate the effects of COVID-19 vaccination in patients with ITP on platelet count, bleeding complications, and ITP exacerbation (≥50% decline in platelet count, or nadir platelet count < 30 × 109/L with a >20% decrease from baseline, or use of rescue therapy). Platelet counts in patients with ITP and healthy controls were collected immediately before and 1 and 4 weeks after the first and second vaccinations. Linear mixed-effects modeling was applied to analyze platelet counts over time. We included 218 patients with ITP (50.9% female; mean age, 55 years; and median platelet count, 106 × 109/L) and 200 healthy controls (60.0% female; mean age, 58 years; median platelet count, 256 × 109/L). Platelet counts decreased by 6.3% after vaccination. We did not observe any difference in decrease between the groups. Thirty patients with ITP (13.8%; 95% confidence interval [CI], 9.5-19.1) had an exacerbation and 5 (2.2%; 95% CI, 0.7-5.3) suffered from a bleeding event. Risk factors for ITP exacerbation were platelet count < 50 × 109/L (odds ratio [OR], 5.3; 95% CI, 2.1-13.7), ITP treatment at time of vaccination (OR, 3.4; 95% CI, 1.5-8.0), and age (OR, 0.96 per year; 95% CI, 0.94-0.99). Our study highlights the safety of COVID-19 vaccination in patients with ITP and the importance of the close monitoring of platelet counts in a subgroup of patients with ITP. Patients with ITP with exacerbation responded well on therapy.
Original languageEnglish
Pages (from-to)1637-1644
Number of pages8
JournalBlood advances
Issue number6
Publication statusPublished - 1 Mar 2022

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Publisher Copyright: © 2022 by The American Society of Hematology.


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