Evidence map›Paper›PMID 37701717›Full record

ArticleThe Lancet regional health. Western Pacific2023

The clinicopathological features of thrombosis with thrombocytopenia syndrome following ChAdOx1-S (AZD1222) vaccination and case outcomes in Australia: a population-based study.

Huyen A Tran, Lucy Deng, Nicholas Wood, Philip Choi, Sally Singleton, Lisa Clarke, Sarah Khanlari, Isis Maitland-Scott, Robert Bird, Scott Brown and 21 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Western Pacific, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 14% 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

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Guideline
  2. Observational
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

31 authors at 15 institutions in 1 country.

Huyen A TranThe Alfred Hospital, Melbourne, Victoria, Australia.
Lucy DengNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Nicholas WoodNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Philip ChoiThe Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Sally SingletonACT Health Directorate, Canberra, Australian Capital Territory, Australia.
Lisa ClarkeDepartment of Haematology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.
Sarah KhanlariNew South Wales Ministry of Health, St Leonards, New South Wales, Australia.
Isis Maitland-ScottNew South Wales Ministry of Health, St Leonards, New South Wales, Australia.
Robert BirdDivision of Cancer Services, Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Scott BrownQueensland Health, Brisbane, Queensland, Australia.
Bavahuna ManoharanQueensland Health, Brisbane, Queensland, Australia.
Chee Wee TanRoyal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia.
Michael GoldDepartment of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia.
Pravin HissariaRoyal Adelaide Hospital, Central Area Local Health Network, Adelaide, South Australia, Australia.
Shannon MelodyPublic Health Services, Tasmania Department of Health, Hobart, Tasmania, Australia.
Sanjeev D Chunilal SMonash Medical Centre, Clayton, Victoria, Australia.
Jim ButterySAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Hazel ClothierSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Nigel W CrawfordSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Linny PhuongSAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Dominic PepperellFiona Stanley Hospital, Perth, Western Australia, Australia.
Paul EfflerWestern Australian Department of Health, Perth, Western Australia, Australia.
Claire ParkerWestern Australian Department of Health, Perth, Western Australia, Australia.
Nicola CarterNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Kristine MacartneyNational Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Megan McSteaAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia.
Todd MillerAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia.
Michael NissenFaculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Claire LarterAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia.
Elspeth KayAustralian Commonwealth Department of Health and Aged Care, Canberra, Australian Capital Territory, Australia.
Vivien M ChenDepartment of Haematology and NSW Health Pathology, Concord Hospital Sydney, New South Wales, Australia.
The University of Sydney · AUDepartment of Health and Aged Care · AUGovernment of Western Australia Department of Health · AURoyal Children's Hospital · AUMonash Medical Centre · AUQueensland Health · AUSouth Australia Pathology · AUAct Health · AUAustralian National University · AUAustralian Red Cross Lifeblood · AUFiona Stanley Hospital · AUMurdoch Children's Research Institute · AUPrincess Alexandra Hospital · AUThe University of Queensland · AUWomen's and Children's Health Network · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. We report the clinicopathological features of TTS following ChAdOx1-S vaccination and summarise the case outcomes in Australia. Methods: In this cohort study, patients diagnosed with TTS in Australia between 23 March and 31 December 2021 were identified according to predefined criteria. Cases were included if they met the Therapeutic Goods Administration (TGA) probable and confirmed case definitions and were reclassified using Centres for Disease Control and Prevention (CDC) definition for analysis. Data were collected on patient baseline characteristics, clinicopathological features, risk factors, treatment and outcomes. Findings: A total of 170 TTS cases were identified, with most occurring after the first dose (87%) of ChAdOx1-S. The median time to symptom onset after vaccination and symptom onset to admission was 11 and 2 days respectively. The median age of cases was 66 years (interquartile range 55-74). All except two patients received therapeutic anticoagulation and 66% received intravenous immunoglobulin. Overall, 85.3% of cases were discharged home after a median hospitalisation of 6 days, 9.4% required ongoing rehabilitation and 5.3% died. Eight deaths were related to TTS, with another dying from an unrelated condition while receiving treatment for TTS. Deaths occurred more commonly in those classified as Tier 1 according to the CDC definition and were associated with more severe thrombocytopenia and disease-related haemorrhage. Interpretation: TTS, while rare, can be severe and have catastrophic outcomes in some individuals. In Australia, the mortality rate was low compared to that reported in other high-income countries. Almost all received therapeutic anticoagulation with no bleeding complications and were successfully discharged. This emphasises the importance of community education and an established pathway for early recognition, diagnosis and treatment of TTS. Funding: Australian Commonwealth Department of Health and Aged Care. H.A Tran, N. Wood, J. Buttery, N.W. Crawford, S.D. Chunilal, V.M. Chen are supported by Medical Research Future Funds (MRFF) grant ID 2015305.

Indexed as

Adverse eventsCOVID-19ThrombocytopeniaThrombosisVaccination

Identifiers

PMID37701717
PMCPMC10494168
OpenAlexW4386412864

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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.