Surgery following the Astra Zeneca Vaccine
12 May 2021
The college’s Safety and Quality Committee has sought expert advice about surgery for those who have had the AstraZeneca COVID-19 vaccination.
There are no theoretical concerns for elective surgical patients who have recently received the AstraZeneca COVID-19 vaccine, except in the case where a patient has developed thrombosis with thrombocytopenia syndrome (TTS).
Also known as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT), TTS is a new syndrome that has been reported in people who have had the AstraZeneca COVID-19 vaccination. The syndrome is characterised by thrombosis (such as central venous sinus thrombosis or splanchnic thrombosis) and thrombocytopenia; and is confirmed with a positive platelet factor 4 and heparin complex enzyme-linked immunosorbent assay (PF4-heparin ELISA).
It should be emphasised that there are two distinct syndromes - general thrombosis (including those associated with surgery or hospitalisation), and this distinct thrombosis with thrombocytopenia syndrome which appears to be associated with the presence of a specific antibody that activates platelets. The clotting seen with this antibody is generally severe and in unusual sites (for example, central venous sinuses and splanchnic circulation).
Clinicians should be mindful of any unusual adverse event that develops following immunisation. Patients who present with unusual or severe symptoms (for example, persistent severe headache) should seek medical attention, and assessing clinicians should perform a platelet count, D-dimer, fibrinogen, and imaging (for example, a computed tomography (CT) of the head) as clinically indicated.
It is recommended to not schedule COVID-19 vaccination within 1 week before elective surgery or 1 week after elective or non-elective surgery . This will reduce the chance that adverse events following the vaccination, such as fever, are attributed as a complication of surgery, such as a surgical wound infection.
To date, the Pfizer (Comirnaty) COVID-19 vaccine is not associated with TTS.