NICE has today published a new rapid COVID-19 guideline to help
healthcare staff identify and treat patients who develop the rare
syndrome vaccine-induced immune thrombocytopenia and thrombosis
(VITT) after receiving COVID-19 vaccinations.
Thrombocytopenia is a condition where a person has a low platelet
count, while thrombosis is the formation of blood clots. Although
extremely rare, with only 14.2 cases occurring per million doses
of COVID-19 vaccine, this condition can be very serious and
requires swift diagnosis and urgent treatment.
This new guideline outlines how to identify people with suspected
VITT, and what tests should be carried out to confirm they have
VITT. The recommendations also cover treatment options for people
with VITT depending on how serious their syndrome is and how
their symptoms react to treatment.
The guideline recommends that healthcare staff refer people with
suspected VITT who are acutely unwell to the emergency department
immediately. If the person is not acutely unwell and results can
be obtained and reviewed on the same day, then a full blood count
should be performed in primary care. If these blood tests show a
low platelet count then the person should then be referred to the
emergency department on the same day.
If blood tests indicate the person is unlikely to have VITT, then
healthcare staff should discuss the signs and symptoms of VITT
with them and provide advice on when and where to seek further
medical attention if their symptoms persist or worsen. If a high
clinical suspicion of VITT remain then they should consider
repeating the full blood count after two to three days if
symptoms worsen, or discuss further tests with a clinical
haematologist.
VITT is confirmed using a test called an ELISA (enzyme-linked
immunosorbent assay), that detects a certain antibody that people
with VITT have called platelet factor 4 (PF4). However, if
healthcare staff suspect that a patient has VITT they should
start treatment in consultation with a haematologist without
waiting for ELISA results.
If the person has developed thrombosis, healthcare staff should
perform same-day imaging tests such as a CT scan to confirm where
the blood clot is before starting treatment.
Dr Paul Chrisp, director of NICE’s Centre for Guidelines,
said: “Although VITT is a very rare condition, it’s
crucial that healthcare professionals feel supported and able to
swiftly identify and treat the small number of people who do
develop it.
“This is a living guideline, which can be continuously updated to
incorporate the latest evidence and keep abreast of new
developments.
“This guideline has not looked at the safety of COVID-19
vaccines; that is not NICE’s remit and the data from the MHRA
shows the benefits of COVID vaccines far outweigh the risks.
NICE’s role here is to provide the best advice to help clinicians
treat patients in the rare instances where they do develop VITT.”
The guideline recommends treatment options for people with VITT,
including non-heparin anticoagulation drugs and surgical
interventions to treat thrombosis. Patients should also initially
receive intravenous immunoglobulin to treat the VITT immune
response. The guideline recommends that a haematologist should be
involved in decisions around starting or stopping treatments.
When discharged from hospital, patients should continue to be
monitored by the haematology department and advised what to do if
their symptoms worsen.
As with the managing COVID-19 guideline, the VITT guideline has
been developed and published in the MAGICapp platform, a global
system that promotes evidence sharing from different guideline
creators, therefore increasing the speed at which recommendations
can be developed and the ease with which they can be updated.
The guideline can be read here.
ENDS
Notes to editors
About the guideline
Putting recommendations into practice can take time. How long
will vary from guideline to guideline, and will depend on how
much change in practice or services is needed. Implementing
change is most effective when aligned with local priorities. When
exercising their judgement, professionals and practitioners are
expected to take this guideline fully into account, alongside the
individual needs, preferences and values of their patients or the
people using their service. It is not mandatory to apply the
recommendations, and the guideline does not override the
responsibility to make decisions appropriate to the circumstances
of the individual, in consultation with them and their families
and carers or guardian.
