Infections

VITT update: guidance for respiratory physicians


A one-page multidisciplinary guideline on vaccine-induced immune thrombotic thrombocytopenia (VITT) has been made available for frontline doctors including respiratory physicians.

Dr Andrew Burke was the TSANZ representative on the development of the guideline.

The communication document for GPs, various physician specialities, surgeons, ED and ICU doctors is based on the full VITT advisory statement by the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ).

Associate Professor Vivien Chen, from Concord Hospital and head of the Platelet and Thrombosis Research Laboratory at the ANZAC Research Institute, told the limbic that the THANZ guidance was still being updated weekly.

She said the live document has allowed the team to refine its recommendations and definitions.

“For example, as of last week we have put in a little more guidance as to what people might want to be thinking about post the acute phase, based upon what we have been seeing with patients over this last month and a half.”

“So the full guidance remains there particularly for specialist care. But what we really wanted to do is have a one-page document for the frontline individual that is seeing these patients to know what to do in the acute phase.”

“All of the information is taken from the full advisory document and as the full advisory document is updated the communication document will be updated in parallel.”

She said input from other disciplines enabled a document with the language and format that would be most helpful to ensure suspected VITT patients were recognised and investigated accurately.

“What we hoped to do was get input from as many different stakeholders as we could as to what kind of information people needed to be able to make the right decision for the patient in front of them. We just wanted to have it accessible for everybody but also to make sure that what we were suggesting was possible in the real world,” Associate Professor Chen said.

She said while it was important to identify the people that might have the syndrome and get them treated appropriately, it was equally important to be able to say which people do not have syndrome and make sure they were treated appropriately as well.

“For example, those who are not going to be treated like a patient with VITT at this point but there are certain blood tests like the raised D-dimer which make us want to have a second blood test in a few days time. So those patients need to go back to their GP and be followed up both clinically and with blood tests.”

Dr Chen said the evidence was that Australian clinicians were recognising patients as they presented, appropriately referring them for testing and treating them in the meantime according to the guidance statement.

“And certainly in the last few weeks we have seen patients progress very well using the pathway with early treatment.”

An expert haematology panel in Britain have also recently released their guidance on VITT.

“Our guidance is a bit different to the British and it is really informed by our situation here and the cases that we are seeing and we have crafted our guidance around the safety of being able to capture all cases and get them on the correct pathway and getting them off the pathway as soon as possible.”

“One of the big differences is the British say that if your platelet count is normal, then you don’t need to go further. We really like to have that whole package together – the combination of timeframe, symptoms, a fall in platelet count, a raised D-dimer and/or low fibrinogen – and use that to guide down decision trees as to the diagnostic and management pathway.”

Associate Professor Chen said the general vaccination message was that the risk of VITT associated with the COVID-19 vaccine was very low but people should know what the signs and symptoms were and if they occur, to visit a GP or ED and get tested.

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