Evidence map›Paper›PMID 34107198›Full record

ArticleThe New England journal of medicine2021

Adjunct Immune Globulin for Vaccine-Induced Immune Thrombotic Thrombocytopenia.

Alex Bourguignon, Donald M Arnold, Theodore E Warkentin, James W Smith, Tania Pannu, Jeffrey M Shrum, Zainab A A Al Maqrashi, Anjali Shroff, Marie-Claude Lessard, Normand Blais and 2 more

Open access · bronzeAbstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in The New England journal of medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 116 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
116citing papers in PubMed, 8 pooled it
36.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

116 citing papers in PubMed, 8 syntheses or guidelines pooled it, 192 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Guideline
  6. Pooled it
  7. Pooled it
  8. Thrombosis with Thrombocytopenia Syndrome After Administration of AZD1222 or Ad26.COV2.S Vaccine for COVID-19: A Systematic Review.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
  9. Review
  10. Adenoviral Inciting Antigen and Somatic Hypermutation in VITT.The New England journal of medicine · 2026
    Observational
  11. Article
  12. Review
  13. Article
  14. Review
  15. Article
  16. Article
  17. Anti-Platelet factor 4 immunothrombosis-not just heparin and vaccine triggers.Research and practice in thrombosis and haemostasis · 2025
    Review
  18. Review
  19. Review
  20. Article

56 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

  • Commented on by
    2022
5 · Who and what money

Authors and funding

12 authors at 1 institution in 1 country.

Alex BourguignonFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Donald M ArnoldFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.ORCID 0000-0003-0943-8853
Theodore E WarkentinFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.ORCID 0000-0002-8046-7588
James W SmithFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Tania PannuFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Jeffrey M ShrumFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Zainab A A Al MaqrashiFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Anjali ShroffFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Marie-Claude LessardFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Normand BlaisFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
John G KeltonFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
Ishac NazyFrom the Departments of Medicine (A.B., D.M.A., T.E.W., J.W.S., Z.A.A.A.M., A.S., J.G.K., I.N.) and Pathology and Molecular Medicine (A.B., T.E.W.), Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (T.P., J.M.S.), the Department of Hematology/Oncology, Centre Hospitalier de l'Université de Montreal, Montreal (N.B.), and the Department of Hematology/Oncology, Hôpital Régional de Saint-Jérôme, St. Jerome, QC (M.-C.L.) - all in Canada.
University of Calgary · CA

Funding

Institute of Circulatory and Respiratory Health CIHR #452655
6 · The paper itself

Abstract

The use of high-dose intravenous immune globulin (IVIG) plus anticoagulation is recommended for the treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare side effect of adenoviral vector vaccines against coronavirus disease 2019 (Covid-19). We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients. (Funded by the Canadian Institutes of Health Research.).

Indexed as

Immunoglobulins, IntravenousAgedChAdOx1 nCoV-19COVID-19 VaccinesFemaleFibrin Fibrinogen Degradation ProductsFibrinogenHeparinHumansMaleMiddle AgedPlatelet CountPlatelet Factor 4SerotoninThrombocytopeniaThrombosisChAdOx1 nCoV-19COVID-19 VaccinesFibrin Fibrinogen Degradation Productsfibrin fragment DFibrinogenHeparinImmunoglobulins, IntravenousPlatelet Factor 4Serotonin

Identifiers

PMID34107198
PMCPMC8362588
OpenAlexW3170777512

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.