NICE publishes ‘rapid’ guideline on rare blood clots associated with COVID-19 jab

The UK’s National Institute for Health and Care Excellence (NICE) has published a new guideline of the rare syndrome vaccine-induced immune thrombocytopenia and thrombosis (VITT) associated with COVID-19 vaccination.

The new guideline outlines how to diagnose people with suspected VITT and what tests should be conducted to confirm they have this conditions.

Thrombocytopenia is characterised by low platelet counts, while thrombosis is the formation of blood clots.

The condition is extremely rare, with only 14.2 cases occurring per million doses of the COVID-19 vaccine – however, it can be very serious and requires ‘swift diagnosis and urgent treatment’.

In the new guideline, NICE recommends that healthcare staff refer those with suspected VITT who are acutely unwell to the emergency department immediately.

If a 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 those tests then show a person has a low platelet count, they should then be referred to the emergency department on the same day.

Meanwhile, if blood tests indicate a person is unlikely to have VITT, healthcare staff should then discuss the signs and symptoms of the condition with them, providing advice on when and where to seek further medical attention if they develop symptoms.

VITT is confirmed using a diagnostic test called an ELISE that detects the platelet factor 4 (PF4) antibody.

However, NICE recommends that if healthcare staff suspect a patient has VITT, they should still begin treatment in consultation with a haematologists without waiting for ELISA results.

“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,” said Paul Chrisp, director of NICE’s centre for guidelines.

“This is a living guideline, which can be continuously updated to incorporate the latest evidence and keep abreast of new developments,” he added.