Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Persistently High Platelet Factor 4 Levels in an Adolescent With Recurrent Late Thrombotic Complications After SARS-CoV-2 mRNA Vaccination

Yoichi Haga
* ORCID logo ,
Akira Ohara
ORCID logo ,
Tsuneyoshi Yakuwa
,
Akari Yamashita
,
Midori Udo
,
Masaki Matsuoka
,
Hiroshi Ohara
,
Atsushi Yasumoto
,
Hiroyuki Takahashi
Version 1 : Received: 24 April 2024 / Approved: 26 April 2024 / Online: 28 April 2024 (07:30:58 CEST)

How to cite: Haga, Y.; Ohara, A.; Yakuwa, T.; Yamashita, A.; Udo, M.; Matsuoka, M.; Ohara, H.; Yasumoto, A.; Takahashi, H. Persistently High Platelet Factor 4 Levels in an Adolescent With Recurrent Late Thrombotic Complications After SARS-CoV-2 mRNA Vaccination. Preprints 2024, 2024041727. https://doi.org/10.20944/preprints202404.1727.v1 Haga, Y.; Ohara, A.; Yakuwa, T.; Yamashita, A.; Udo, M.; Matsuoka, M.; Ohara, H.; Yasumoto, A.; Takahashi, H. Persistently High Platelet Factor 4 Levels in an Adolescent With Recurrent Late Thrombotic Complications After SARS-CoV-2 mRNA Vaccination. Preprints 2024, 2024041727. https://doi.org/10.20944/preprints202404.1727.v1

Abstract

Thrombosis after severe acute respiratory syndrome coronavirus 2 vaccination is a serious complication in patients who have a thrombophilic predisposition. In this case, a female patient with no family history of thrombophilia who had pediatric antiphospholipid syndrome (APS) developed deep vein thrombosis (DVT) when she was 6 years old; 6 months after receiving a second dose of the BNT162b2 vaccine, DVT reoccurred. The original thrombi were found in the right common iliac vein and the inferior vena cava, with concomitant left pulmonary infarction. The patient was treated with anticoagulants for 6 years after DVT onset, with subsequent treatment cessation for 5 years without recurrence. She received the BNT162b2 vaccine at 17 years of age, 1 week before a routine outpatient visit. Platelet factor 4 elevation was detected 14 days after the first vaccination, persisting for 5 months without thrombotic symptoms. Six months after the second vaccine dose, the DVT recurred and was treated with a direct oral anticoagulant. The vaccine exacerbated the patient’s APS by activating coagulation, causing thrombosis recurrence. Platelet factor 4 levels may indicate coagulation status. When patients predisposed to thrombosis are vaccinated, coagulation status and platelet activation markers should be monitored to prevent DVT development.

Keywords

 platelet factor 4; SARS-CoV-2 vaccine; venous thrombosis; antiphospholipid syndrome; anticoagulants 

Subject

Medicine and Pharmacology, Hematology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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