akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2025.610akusherstvo-2347Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫImmune paradoxes of vaccine-induced thrombotic thrombocytopenia (VITТ), heparin-induced thrombocytopenia (HIT) and thrombosis: from general mechanisms to the unique VITТ and HIT courseИммунные парадоксы вакцининдуцированной тромботической тромбоцитопении (ВИТТ), гепарин-индуцированной тромбоцитопении (ГИТ) и тромбозов: от общих механизмов к уникальному течению ВИТТ и ГИТhttps://orcid.org/0000-0001-7415-4633МакацарияА. Д.MakatsariyaA. D.

Макацария Александр Давидович, д.м.н., проф., академик РАН

Scopus Author ID: 57222220144

WoS ResearcherID: M-5660-2016

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Alexander D. Makatsariya, MD, Dr Sci Med, Prof., Academician of RAS

Scopus Author ID: 57222220144

WoS ResearcherID: M-5660-2016

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0001-6012-453XАкиньшинаС. В.AkinshinaS. V.

Светлана Владимировна Акиньшина, к.м.н

Scopus Author ID: 15072687000

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Svetlana V. Akinshina, MD, PhD

Scopus Author ID: 15072687000

8 bldg. 2, Trubetskaya Str., Moscow 119991

Svetlana_akin@mail.ruhttps://orcid.org/0000-0002-4509-9281ВоробьевА. В.VorobevA. V.

Воробьев Александр Викторович, к.м.н. 

Scopus Author ID: 57191966265

Wos ResearcherID: F-8804-2017

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Alexander V. Vorobev, MD, PhD

Scopus Author ID: 57191966265

Wos ResearcherID: F-8804-2017

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0001-8404-1042БицадзеВ. О.BitsadzeV. O.

Бицадзе Виктория Омаровна, д.м.н., проф., профессор РАН 

Scopus Author ID: 6506003478

WoS ResearcherID: F-8409-2017

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Victoria O. Bitsadze, MD, Dr Sci Med, Prof., Professor RAS

Scopus Author ID: 6506003478

WoS ResearcherID: F-8409-2017

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0002-0725-9686ХизроеваД. Х.KhizroevaJ. Kh.

Хизроева Джамиля Хизриевна, д.м.н., проф. 

Scopus Author ID: 57194547147

WoS ResearcherID: F-8384-2017

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Jamilya Kh. Khizroeva, MD, Dr Sci Med, Prof/

Scopus Author ID: 57194547147

WoS ResearcherID: F-8384-2017

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0002-3628-0804ТретьяковаМ. В.TretyakovaM. V.

Третьякова Мария Владимировна, к.м.н.

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Maria V. Tretyakova, MD, PhD

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0002-2541-3843МакацарияН. А.MakatsariyaN. A.

Макацария Наталия Александровна, к.м.н.

WoS ResearcherID: F-8406-2017

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Nataliya A. Makatsariya, MD, PhD.

WoS ResearcherID: F-8406-2017

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0002-2070-1192КалашниковаИ. С.KalashnikovaI. S.

Калашникова Ирина Сергеевна, к.м.н. 

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Irina S. Kalashnikova, MD, PhD.

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0003-0764-4477ГашимоваН. Р.GashimovaN. R.

Гашимова Нилуфар Рамиль кызы, к.м.н.

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Nilufar R. Gashimova, MD, PhD. 

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0002-7756-8935ГригорьеваК. Н.GrigorevaK. N.

Григорьева Кристина Николаевна, к.м.н.

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Kristina N. Grigoreva, MD, PhD. 

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0009-0005-0838-2319СтепановИ. А.StepanovI. A.

Степанов Иван Алексеевич

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Ivan A. Stepanov

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0009-0001-3406-9757ДикареваИ. М.DikarevaI. M.

Дикарева Ирина Максимовна

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Irina M. Dikareva

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0001-6831-8945ТатаринцеваА. Ю.TatarintsevaA. Yu.

Татаринцева Алёна Юрьевна

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Alena Yu. Tatarintseva

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0003-2136-1641ЛазарчукА. В.LazarchukA. V.

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Arina V. Lazarchuk

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0009-0003-5190-4958ХисамиеваА. Р.KhisamievaA. R.

Хисамиева Азалия Рустемовна

119991 Москва, ул. Трубецкая, д. 8, стр. 2

Azaliia R. Khisamieva

8 bldg. 2, Trubetskaya Str., Moscow 119991

https://orcid.org/0000-0002-3367-9844БлиновД. В.BlinovD. V.

Блинов Дмитрий Владиславович, к.м.н.

Scopus Author ID: 6701744871

WoS ResearcherID: E-8906-2017

101000 Москва, Лялин переулок, д. 11–13/1;123056 Москва, 2-я Брестская ул., д. 5, с. 1–1а; 141551 Московская область, деревня Голубое, Родниковая ул., стр. 6, к. 1

Dmitry V. Blinov, MD, PhD, MBA.

Scopus Author ID: 6701744871

WoS ResearcherID: E-8906-2017

11–13/1 Lyalin Pereulok, Moscow 101000; 5 bldg. 1–1a, 2-ya Brestskaya Str., Moscow 123056; 6 bldg. 1, Rodnikovaya Str., Village Goluboe, Moscow region 141551

https://orcid.org/0000-0001-8120-4782Ван ДреденП.Van DredenP.

Ван Дреден Патрик, д.м.н., проф. 

Scopus Author ID: 55915955300

Париж, INSERM UМR_S_938

Patrick Van Dreden, MD, Dr Sci Med, Prof.

Scopus Author ID: 55915955300

NSERM UМR_S_938, Paris

https://orcid.org/0000-0002-9899-9910ГриЖ.-К.GrisJ.-Ch.

Гри Жан-Кристоф, д.м.н., проф.

Scopus Author ID: 7005114260

WoS ResearcherID: AAA-2923-2019

119991 Москва, ул. Трубецкая, д. 8, стр. 2; 34090 Монпелье, ул. Огюста Бруссоне, д. 163

Jean-Christophe Gris, MD, Dr Sci Med, Prof. 

Scopus Author ID: 7005114260

WoS ResearcherID: AAA-2923-2019

8 bldg. 2, Trubetskaya Str., Moscow 119991; 163 Rue Auguste Broussonnet, Montpellier 34090

https://orcid.org/0000-0002-9576-1368ЭлаламиИ.ElalamyI.

Элалами Исмаил, д.м.н., проф. 

Scopus Author ID: 7003652413

WoS ResearcherID: AAC-9695-2019

119991 Москва, ул. Трубецкая, д. 8, стр. 2; 75006 Париж, Улица медицинского факультета, д. 12;75020 Париж, Китайская улица, д. 4

Ismail Elalamy, MD, Dr Sci Med, Prof.

Scopus Author ID: 7003652413

WoS ResearcherID: AAC-9695-2019

8 bldg. 2, Trubetskaya Str., Moscow 119991; 12 Rue de l’École de Médecine, Paris 75006; Hospital Tenon

https://orcid.org/0000-0003-2316-6348ГеротзиафасГ.GerotziafasG.

Геротзиафас Григориос, д.м.н., проф. 

119991 Москва, ул. Трубецкая, д. 8, стр. 2; 75006 Париж, Улица медицинского факультета, д. 12;75020 Париж, Китайская улица, д. 4

Grigoriоs Gerotziafas, MD, Dr Sci Med, Prof. 

8 bldg. 2, Trubetskaya Str., Moscow 119991; 12 Rue de l’École de Médecine, Paris 75006; 4 Rue de la Chine, Paris 75020

ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian FederationИнститут Превентивной и Социальной Медицины; АНО ДПО «Московский медико-социальный институт имени Ф.П. Гааза»; ФГБУ «Федеральный научно-клинический центр медицинской реабилитации и курортологии Федерального медико-биологического агентства»РоссияInstitute for Preventive and Social Medicine; Moscow Haass Medical – Social Institute; Federal Scientific and Clinical Center for Medical Rehabilitation and Balneology, Federal Medical-Biological AgencyRussian FederationУниверситет СорбонныФранцияSorbonne UniversityFranceФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Университет МонпельеРоссияSechenov University; University of MontpellierRussian FederationФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Медицинский Университет Сорбонны; Госпиталь ТенонРоссияSechenov University; Medicine Sorbonne University; Hospital TenonRussian Federation20250603202519197109Copyright © Makatsariya A.D., Akinshina S.V., Vorobev A.V., Bitsadze V.O., Khizroeva J.K., Tretyakova M.V., Makatsariya N.A., Kalashnikova I.S., Gashimova N.R., Grigoreva K.N., Stepanov I.A., Dikareva I.M., Tatarintseva A.Y., Lazarchuk A.V., Khisamieva A.R., Blinov D.V., Van Dreden P., Gris J., Elalamy I., Gerotziafas G., 20252025Макацария А.Д., Акиньшина С.В., Воробьев А.В., Бицадзе В.О., Хизроева Д.Х., Третьякова М.В., Макацария Н.А., Калашникова И.С., Гашимова Н.Р., Григорьева К.Н., Степанов И.А., Дикарева И.М., Татаринцева А.Ю., Лазарчук А.В., Хисамиева А.Р., Блинов Д.В., Ван Дреден П., Гри Ж., Элалами И., Геротзиафас Г.Makatsariya A.D., Akinshina S.V., Vorobev A.V., Bitsadze V.O., Khizroeva J.K., Tretyakova M.V., Makatsariya N.A., Kalashnikova I.S., Gashimova N.R., Grigoreva K.N., Stepanov I.A., Dikareva I.M., Tatarintseva A.Y., Lazarchuk A.V., Khisamieva A.R., Blinov D.V., Van Dreden P., Gris J., Elalamy I., Gerotziafas G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2347Aim

Aim: to carry out a comparative analysis of the pathogenesis, clinical manifestations, diagnostic criteria as well as therapeutic strategies of vaccine-induced thrombotic thrombocytopenia (VITТ) and heparin-induced thrombocytopenia (HIT), two rare but potentially life-threatening conditions associated with antibody-dependent platelet activation.

Materials and Methods

Materials and Methods. Current data on the pathogenesis, epidemiology, clinical presentation, diagnosis, and treatment of VITТ and HIT have been reviewed including an analysis of existing diagnostic scoring systems, laboratory tests, and therapeutic approaches. The study is based on the data obtained from systematic reviews, clinical studies, and up-to-date clinical guidelines.

Results

Results. VITТ and HIT share a common pathophysiological mechanism involving the production of antibodies against platelet factor 4 (PF4) and subsequently developing thrombotic complications. However, a key difference lies in the triggers of the immune response: HIT is induced by heparin exposure, whereas VITТ develops following the administration of adenoviral vector vaccines against SARS-CoV-2. HIT is primarily characterized by venous thrombosis, while VITТ predominantly manifests with atypical thromboses, including cerebral venous sinus thrombosis. Both conditions require immediate medical intervention; however, HIT management involves discontinuation of heparin and the initiation of using alternative anticoagulants, whereas VITТ treatment requires administration of intravenous immunoglobulins and anticoagulants, including heparin-based agents.

Conclusion

Conclusion. Despite their rarity, VITТ and HIT pose significant health risks to patients. Modern diagnostic methods, including the 4Тs scoring system and serological testing, facilitate the timely identification of HIT, whereas VITТ diagnostics remains a complex challenge and requires further standardization. Optimizing therapeutic strategies, including the use of novel anticoagulants and immunosuppressive approaches, is a priority task to reduce mortality and improve patient outcomes.

Цель

Цель: сравнительный анализ патогенеза, клинических проявлений, диагностических критериев и терапевтических стратегий вакцин-индуцированной тромботической тромбоцитопении (ВИТТ) и гепарин-индуцированной тромбоцитопении (ГИТ) – двух редких, но потенциально жизнеугрожающих состояний, связанных с антителозависимой активацией тромбоцитов.

Материалы и методы

Материалы и методы. Выполнен обзор современных данных по патогенезу, эпидемиологии, клинике, диагностике и лечению ВИТТ и ГИТ, включая анализ существующих диагностических шкал, лабораторных тестов и терапевтических подходов. Методология обзора включала анализ данных систематических обзоров, клинических исследований и актуальных клинических рекомендаций.

Результаты

Результаты. ВИТТ и ГИТ объединяет общий патогенетический механизм, связанный с выработкой антител против фактора 4 тромбоцитов (англ. platelet factor 4, PF4) и развитием тромботических осложнений. Однако ключевое различие заключается в триггерах иммунного ответа: ГИТ индуцируется применением гепарина, тогда как ВИТТ развивается после введения аденовирусных векторных вакцин против SARS-CoV-2. ГИТ характеризуется тромбозами венозного русла, тогда как ВИТТ проявляется преимущественно атипичными тромбозами, включая церебральные венозные синусы. Оба состояния требуют немедленного вмешательства, но терапия ГИТ основывается на отмене гепарина и назначении альтернативных антикоагулянтов, тогда как ВИТТ требует применения внутривенных иммуноглобулинов и антикоагулянтов, в том числе препаратов гепарина.

Заключение

Заключение. Несмотря на редкость, ВИТТ и ГИТ представляют серьезную угрозу здоровью пациентов. Современные диагностические методы, включая шкалу 4T и серологическое тестирование, позволяют своевременно выявлять ГИТ, в то время как диагностика ВИТТ остается сложной и требует дальнейшей стандартизации. Оптимизация терапевтических стратегий, включая применение новых антикоагулянтов и иммуносупрессивных методов, является приоритетной задачей для снижения смертности и улучшения исходов у пациентов с данными состояниями.

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The authors declare that there are no conflicts of interest present.