Changes in thrombosis-related parameters after AstraZeneca COVID-19 vaccination in a male volunteer: a case report

• Published in: Journal of medical case reports 2022-08, Vol.16 (1), p.1-326, Article 326
• Main Authors: Hong, Sae-Yong, Jun, Sang-Sin, Seo, Sang-Wook, Park, Jeong-Rae, Im, Joung-Il
• Format: Article
• Language: English
• Subjects: Adverse drug reaction; Antigens; Blood; Blood clot; Blood coagulation; Blood coagulation factors; Case Report; Case reports; Complications and side effects; Coronaviruses; COVID-19 vaccine; COVID-19 vaccines; Fibrin; Fibrinolysis; Immunization; Laboratories; Medical examination; Pharmaceutical industry; Protein C; Thrombosis; Vaccination; Virus diseases
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-022-03563-9

Background We speculated that subclinical thrombosis may occur frequently through crosstalk between immune/inflammatory reactions and hemostasis after corona virus disease-2019 (COVID-19) vaccination. To test this hypothesis, we measured thrombosis-related parameters after COVID-19 vaccination in a volunteer for 21 days. Case presentation The following parameters were measured in a 72-year-old Korean man at 1 day before vaccination and on days 1, 3, 7, 14, and 21 post vaccination (AstraZeneca COVID-19 vaccine: ChAdOx1-S/nCoV-19, CTMAV563): complete blood count, platelet indices, thrombin receptor-activating peptide-induced platelet aggregation, prothrombin time, activated partial thromboplastin time, D-dimer, thrombin-antithrombin III complex (TAT), plasmin-[alpha]2 antiplasmin complex (PAP), von Willebrand factor (vWF) antigen and activity, plasminogen activator inhibitor-1 (PAI-1), protein C and protein S antigen and activity, lupus anticoagulant, fibrinogen degradation product, and plasminogen. We found that the TAT had significantly increased from 0.7 ng/mL (baseline) to 21.7 ng/mL (day 1). There was a transient increase in the PAI-1 level from 7.2 ng/mL (baseline) to 10.9 ng/mL (day 3), followed by a decrease in PAP level from 0.9 ng/mL (baseline) to 0.3 [mu]g/mL (day 7), suggesting that plasmin generation is suppressed by PAI-1. Conclusions Increased thrombotic factors (such as decreased protein S) and decreased fibrinolytic activity due to increased PAI-1 were potential factors causing thrombogenesis after COVID-19 vaccination. Sequential measurement of platelet indices, TAT, PAP, protein C, protein S, vWF, D-dimer, and PAI-1 following COVID-19 vaccination was informative. Keywords: COVID-19 vaccine, Adverse drug reaction, Blood coagulation, Fibrinolysis, Case report