Patient cohort with anti-PF4–negative TTS
| Clinical data . | Antibody testing . | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Case . | Sex, age (y) . | Medical history . | Vaccination history . | Symptom onset (days after vaccination) . | Platelet nadir (×109/L) . | Venous thrombosis . | Arterial thrombosis . | Bleeding . | Anti-PF4-heparin IgG ELISA . | PS exposure of washed platelets . | GPIIb/IIIa autoantibodies . | GPIb/IX autoantibodies . | GPIa/IIa autoantibodies . | Anti-Histone IgG ELISA . |
| 1∗ | Male, 57 | IgA nephropathy kidney Tx | 2 × mRNA-1273 | 61 | 29 | SVT, DVT | – | Positive | Positive | Positive | Positive | Positive | ||
| 2∗ | Male, 37 | ITP, Hodgkin lymphoma in remission | 2 × BNT162b2 | 3 | 2 | PE | Petechiae | – | Positive | Positive | Positive | – | Positive | |
| 3 | Male, 71 | 1 × BNT162b2 | 6 | 37 | PE, DVT | Petechiae | – | Positive | Positive | Positive | – | Positive | ||
| 4 | Male, 59 | Previous ITP | 2 × BNT162b2 | >60 | 0 | DVT | Petechiae | – | Positive | – | Positive | – | Borderline | |
| 5 | Male, 58 | 1 × BNT162b2 | 5 | 79 | PE | – | Positive | – | – | – | Positive | |||
| 6 | Male, 49 | 2 × BNT162b2 | 5 | 123 | PE, DVT | – | Positive | – | – | – | Positive | |||
| 7 | Male, 62 | 2 × BNT162b2 | <7 | 119 | PE, DVT | – | Positive | – | – | – | Positive | |||
| 8 | Female, 56 | 1 × BNT162b2 | 10 to 20 | 63 | Acral necrosis | Petechiae | – | Positive | – | – | Positive | Positive | ||
| 9 | Male, 13 | Epilepsy | 2 × BNT162b2 | 2 | 54 | DIC | Petechiae, epistaxis, abdominal | – | Positive | Positive | – | Positive | No material | |
| 10 | Male, 66 | 1 × BNT162b2 | 19 | 29 | Splenic infarction | Petechiae | – | Positive | – | – | – | No material | ||
| 11 | Male, 62 | Previous COVID-19 | 2 × BNT162b2 | 43 | 23 | DVT | Stroke, left ventricle thrombosis | – | Positive | Positive | Positive | – | – | |
| 12 | Female, 50 | 2 × BNT162b2 | 5 | 127 | Stroke | – | Positive | – | – | – | – | |||
| 13 | Male, 29 | 1 × BNT162b2 | 30 | 111 | CSVT | – | – | – | – | – | Positive | |||
| 14 | Male, 83 | 2 × BNT162b2 | 20 | 110 | Stroke | – | – | – | – | – | Positive | |||
| 15 | Female, 20 | Previous COVID-19 | 3 × BNT162b2 | 1 | 12 | CSVT | Petechiae | – | – | – | – | – | Positive | |
| 16 | Male, 76 | 1 × BNT162b2 | Not stated | 11 | Stroke | – | – | – | – | – | No material | |||
| 17 | Male, 80 | 2 × BNT162b2 | Not stated | 76 | CSVT | – | – | – | – | – | – | |||
| 18 | Female, 61 | Cervix carcinoma | 2 × BNT162b2 | <7 | 65 | DVT | – | – | – | – | – | – | ||
| Clinical data . | Antibody testing . | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Case . | Sex, age (y) . | Medical history . | Vaccination history . | Symptom onset (days after vaccination) . | Platelet nadir (×109/L) . | Venous thrombosis . | Arterial thrombosis . | Bleeding . | Anti-PF4-heparin IgG ELISA . | PS exposure of washed platelets . | GPIIb/IIIa autoantibodies . | GPIb/IX autoantibodies . | GPIa/IIa autoantibodies . | Anti-Histone IgG ELISA . |
| 1∗ | Male, 57 | IgA nephropathy kidney Tx | 2 × mRNA-1273 | 61 | 29 | SVT, DVT | – | Positive | Positive | Positive | Positive | Positive | ||
| 2∗ | Male, 37 | ITP, Hodgkin lymphoma in remission | 2 × BNT162b2 | 3 | 2 | PE | Petechiae | – | Positive | Positive | Positive | – | Positive | |
| 3 | Male, 71 | 1 × BNT162b2 | 6 | 37 | PE, DVT | Petechiae | – | Positive | Positive | Positive | – | Positive | ||
| 4 | Male, 59 | Previous ITP | 2 × BNT162b2 | >60 | 0 | DVT | Petechiae | – | Positive | – | Positive | – | Borderline | |
| 5 | Male, 58 | 1 × BNT162b2 | 5 | 79 | PE | – | Positive | – | – | – | Positive | |||
| 6 | Male, 49 | 2 × BNT162b2 | 5 | 123 | PE, DVT | – | Positive | – | – | – | Positive | |||
| 7 | Male, 62 | 2 × BNT162b2 | <7 | 119 | PE, DVT | – | Positive | – | – | – | Positive | |||
| 8 | Female, 56 | 1 × BNT162b2 | 10 to 20 | 63 | Acral necrosis | Petechiae | – | Positive | – | – | Positive | Positive | ||
| 9 | Male, 13 | Epilepsy | 2 × BNT162b2 | 2 | 54 | DIC | Petechiae, epistaxis, abdominal | – | Positive | Positive | – | Positive | No material | |
| 10 | Male, 66 | 1 × BNT162b2 | 19 | 29 | Splenic infarction | Petechiae | – | Positive | – | – | – | No material | ||
| 11 | Male, 62 | Previous COVID-19 | 2 × BNT162b2 | 43 | 23 | DVT | Stroke, left ventricle thrombosis | – | Positive | Positive | Positive | – | – | |
| 12 | Female, 50 | 2 × BNT162b2 | 5 | 127 | Stroke | – | Positive | – | – | – | – | |||
| 13 | Male, 29 | 1 × BNT162b2 | 30 | 111 | CSVT | – | – | – | – | – | Positive | |||
| 14 | Male, 83 | 2 × BNT162b2 | 20 | 110 | Stroke | – | – | – | – | – | Positive | |||
| 15 | Female, 20 | Previous COVID-19 | 3 × BNT162b2 | 1 | 12 | CSVT | Petechiae | – | – | – | – | – | Positive | |
| 16 | Male, 76 | 1 × BNT162b2 | Not stated | 11 | Stroke | – | – | – | – | – | No material | |||
| 17 | Male, 80 | 2 × BNT162b2 | Not stated | 76 | CSVT | – | – | – | – | – | – | |||
| 18 | Female, 61 | Cervix carcinoma | 2 × BNT162b2 | <7 | 65 | DVT | – | – | – | – | – | – | ||
A negative test result is shown by a dash (–).
CVST, cerebral vein sinus thrombosis; DIC, disseminated intravascular anticoagulation; DVT, deep vein thrombosis; ITP, immune thrombocytopenia; PE, pulmonary embolism; SVT, splanchnic vein thrombosis; Tx, treatment or therapy.
Index patients (see detailed case descriptions).