The website of the Clinical Services Journal

NICE guidance on rare blood clots linked to COVID-19 vaccination

NICE has 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.

The guideline can be read at: https://www.nice.org.uk/guidance/indevelopment/gid-ng10230  

 

Upcoming Events

Central Sterilising Club - Annual Scientific Meeting 2024

Crowne Plaza at Gerrard’s Cross
15th April 2024 – 16th April 2024

DECON UK 2024

National Conference Centre, Birmingham
17th April 2024

Infection Prevention & Control

National Conference Centre, Birmingham
23rd - 24th April 2024

Theatres & Decontamination Conference 2024

Coventry Building Society Arena
16th May 2024

The AfPP Roadshow - Birmingham

Millennium Point, Birmingham
18th May 2024

The AfPP Roadshow - Exeter

University of Exeter
22nd June 2024

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

Upcoming Events

Central Sterilising Club - Annual Scientific Meeting 2024

Crowne Plaza at Gerrard’s Cross
15th April 2024 – 16th April 2024

DECON UK 2024

National Conference Centre, Birmingham
17th April 2024

Infection Prevention & Control

National Conference Centre, Birmingham
23rd - 24th April 2024

Theatres & Decontamination Conference 2024

Coventry Building Society Arena
16th May 2024

The AfPP Roadshow - Birmingham

Millennium Point, Birmingham
18th May 2024

The AfPP Roadshow - Exeter

University of Exeter
22nd June 2024

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

Step Communications Ltd, Step House, North Farm Road, Tunbridge Wells, Kent TN2 3DR
Tel: 01892 779999
www.step-communications.com
© 2024 Step Communications Ltd. Registered in England. Registration Number 3893025