Therapeutic plasma exchange (TPE) as a plausible rescue therapy in severe vaccine-induced immune thrombotic thrombocytopenia

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is associated with high titers of immunoglobulin G class antibodies directed against the cationic platelet chemokine factor 4 (PF4). These activate platelets via Fc?IIa receptors. VITT closely resembles heparin-induced thrombocytopenia. Inflammation and tissue trauma substantially increase risk for forming pathogenic PF4 antibodies. We therefore propose use therapeutic plasma exchange as rescue therapy in to deplete plus factors promoting inflammation such excess cytokines circulation well extracellular vesicles derived from activated platelets.