Vaccine · 2026
Clinical, psychological and quality of life outcomes up to 12-months following thrombosis with thrombocytopenia syndrome after ChAdOx1-S (AZD1222) vaccination in Australia.
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Deng Lucy, Barton Belinda, Choi Philip, Clarke Lisa, Khanlari Sarah, Maitland-Scott Isis, Nissen Michael, Tan Chee Wee, Gold Michael, Hissaria Pravin, Melody Shannon, Chunilal Sanjeev, Buttery Jim, Clothier Hazel, Crawford Nigel W, Phuong Linny, Pepperell Dominic, Effler Paul, Macartney Kristine, Chen Vivien, Tran Huyen, Wood Nicholas
Аннотация
BACKGROUND: Thrombosis with thrombocytopenia syndrome (TTS) associated with viral vector COVID-19 vaccines, including ChAdOx1-S (AstraZeneca AZD1222) vaccine, can result in significant morbidity and mortality. However, evidence on long-term clinical and psychosocial outcomes is limited. We report on the 12-month clinical, psychological and health-related quality of life (HRQoL) outcomes of TTS in Australia.
METHODS: In this national cohort study, adults diagnosed with TTS in Australia between 23 March and 31 December 2021 were followed up to 12 months post-discharge. Data were collected on clinical progression, disability, revaccination outcomes, psychological functioning and HRQoL. Psychological functioning and HRQoL were compared between participants with and without persistent clinical symptoms at 12 months.
FINDINGS: Of the 161 TTS surviving cases, 92 (57%) completed 12-month follow-up, with 48% remaining on anticoagulation. Two clinically relevant non-major bleeds, and three new thrombotic events were reported. Most cases (93%) received a subsequent COVID-19 vaccine, with no serious adverse events following immunisation. At 12 months post-discharge, 61% reported persistent symptoms, and had significantly higher levels of psychological distress, including depression, anxiety, and post-traumatic stress, compared to asymptomatic cases. HRQoL scores were significantly poorer than Australian population norms across all physical and mental domains, with only modest improvements in physical and social functioning observed between 6 and 12 months.
CONCLUSION: Recurrent thrombosis and haemorrhagic complications were uncommon; however persistent symptoms at 12-months post-discharge from TTS were frequent and accompanied by substantial functional limitations, psychological distress, and significantly reduced HRQoL. These findings highlight the importance of structured long-term follow-up of TTS, a serious adverse event following immunisation, using a biopsychosocial model of care integrating medical, psychological and functional management and support through a vaccine injury compensation scheme.
METHODS: In this national cohort study, adults diagnosed with TTS in Australia between 23 March and 31 December 2021 were followed up to 12 months post-discharge. Data were collected on clinical progression, disability, revaccination outcomes, psychological functioning and HRQoL. Psychological functioning and HRQoL were compared between participants with and without persistent clinical symptoms at 12 months.
FINDINGS: Of the 161 TTS surviving cases, 92 (57%) completed 12-month follow-up, with 48% remaining on anticoagulation. Two clinically relevant non-major bleeds, and three new thrombotic events were reported. Most cases (93%) received a subsequent COVID-19 vaccine, with no serious adverse events following immunisation. At 12 months post-discharge, 61% reported persistent symptoms, and had significantly higher levels of psychological distress, including depression, anxiety, and post-traumatic stress, compared to asymptomatic cases. HRQoL scores were significantly poorer than Australian population norms across all physical and mental domains, with only modest improvements in physical and social functioning observed between 6 and 12 months.
CONCLUSION: Recurrent thrombosis and haemorrhagic complications were uncommon; however persistent symptoms at 12-months post-discharge from TTS were frequent and accompanied by substantial functional limitations, psychological distress, and significantly reduced HRQoL. These findings highlight the importance of structured long-term follow-up of TTS, a serious adverse event following immunisation, using a biopsychosocial model of care integrating medical, psychological and functional management and support through a vaccine injury compensation scheme.