Vaccine Induced Thrombotic Thrombocytopenia (VITT): First report from India and  utility of risk score for diagnosis in resource limited settings.

Abstract Vaccine induced thrombotic thrombocytopenia (VITT) is a rare but devastating adverse event following adenoviral vector based vaccinations for COVID-19. Guidance statements and available reports lack clarity on the choice of imaging modalities and emphasize on the need for specialized tests as a requisite criterion. Such tests have practical limitations of availability likely to restrict the treatment and reporting of such catastrophic events and need reconsideration. We describe two young men with VITT who had no other contributory cause besides a recent ChAdOx1 nCoV-19 vaccination. They were treated with IVIG and full dose anticoagulation. In both our cases the primary neuroimaging was normal and the recommended PF-4 testing was not reported due to technical limitations. Diagnosis was based on a 4T inspired score. Clinicians should report and though counter intuitive; not delay the institution of full dose anticoagulation, IVIG and limit platelet transfusion in the appropriate setting.