Thrombosis and Bleeding in Patients with Vaccine-Induced Immune Thrombotic Thrombocytopenia: A Systematic Review of Published Cases.

INTRODUCTION: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a highly prothrombotic reaction to COVID-19 (coronavirus disease 2019) adenoviral vector vaccines. Its distinct bleeding and thrombotic patterns compared with other platelet consumptive disorders remain unclear. METHODS: We performed a systematic review of the literature (PubMed and Embase) up to July 31, 2022, including case reports and case series providing nonaggregate data of VITT patients. Accurate VITT diagnosis required fulfillment of the following criteria: (1) endorsement by the authors, (2) consistent vaccine type and timing, (3) presence of thrombocytopenia and thrombosis, (4) detection of anti-platelet factor 4 antibodies. Data are presented as frequencies with 95% confidence intervals (CIs) calculated with the exact binomial method. RESULTS: We retrieved 143 eligible studies, describing 366 patients. Of 647 thrombotic events, 53% (95% CI: 49-56) were venous thromboses at unusual sites and 30% (95% CI: 27-34) were cerebral venous sinus thromboses (CVSTs). The ratio of venous-to-arterial events was 4.1. Thromboses in most sites were associated with at least another thrombotic event, with the exception of CVST and CNS arterial thrombosis (isolated in 49 and 39% of cases, respectively). Bleeding occurred in 36% (95% CI: 31-41) of patients; 68% (95% CI: 59-75) of bleeding events were intracranial hemorrhages (ICHs). Overall mortality was 24% (95% CI: 19-29), and 77% (95% CI: 58-90) in patients with isolated CVST complicated by ICH. CONCLUSION: VITT displays a venous-to-arterial thrombosis ratio comparable to heparin-induced thrombocytopenia. However, VITT is characterized by a higher prevalence of CVST and ICH, which contribute to the increased bleeding frequency and mortality.

Evaluation of Cardiovascular Risk in Patient with Primary Non-alcoholic Fatty Liver Disease.

INTRODUCTION: The study aimed to investigate, in patients with primary non-alcoholic fatty liver disease (NAFLD), the presence of possible relationships between the degree of steatosis or fibrosis and the individual cardiovascular risk and possibly whether a difference between those various methods exists. METHODS: Thirty-four adult patients with primary NAFLD were included in this study. Clinical evaluation included an ultrasonographic examination for the determination of the severity of steatosis. Two different clinical indirect indexes of the severity of hepatic fibrosis were used: the FIB-4 score and the NAFLD fibrosis score. Then, the individual cardiovascular 10-years risk according to 5 different scores: "Progetto Cuore" of the Italian Institute of Health, Framingham score 2004-ATP III, Framingham risk score 2008, ACC/AHA ASCVD risk score 2013, ACC/AHA ASCV risk score new model score 2 were estimated. RESULTS: The severity of steatosis evaluated by ultrasonography was significantly correlated only with ACC/AHA ASCVD RISK 2013, ACC/AHA ASCVD New Model 2 2018 and Framingham 2008 risk scores. The severity of fibrosis evaluated by the FIB-4 score or with NAFLD fibrosis score was significantly correlated only with cardiovascular risk evaluated with ACC/AHA ASCVD 2013, ACC/AHA ASCVD New Model 2 2018 and Framingham risk score 2008. CONCLUSIONS: Some of the methods for the estimation of cardiovascular risk (ACC/AHA ASCVD 2013, new model 2 2018, and, also Framingham score 2008) have a clear advantage over Framingham score 2004 and "Progetto Cuore" of the Italian Institute of Health in terms of correlation with the severity of NAFLD. They are, therefore, more clinically useful.