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A Systematic Review of Vascular Injuries: A Review of Petechiae, Purpura, and Ecchymosis in Critical Situations Following Covid-19 Vaccination Publisher



Kalantari Y1 ; Mirahmadi SMS2 ; Alilou S3 ; Sadeghi S4, 5 ; Aryanian Z6, 7 ; Jafarzadeh A8, 9 ; Goodarzi A8
Authors
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Authors Affiliations
  1. 1. Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Razi Hospital, Vahdat-e-Eslami Square, Tehran, Iran
  2. 2. School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  3. 3. Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
  4. 4. Division of Dermatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
  5. 5. Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
  6. 6. Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
  8. 8. Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
  9. 9. Department of Dermatology, Rasool Akram Medical Complex, Tehran, Iran

Source: Health Science Reports Published:2025


Abstract

Background and Aims: Vascular injuries characterized by petechiae, purpura, and ecchymosis have been reported as potential adverse effects following COVID-19 vaccination. This study aims to identify the characteristics of patients experiencing vascular injuries postvaccination and to outline key clinical considerations. Methods: A systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of Scopus, Web of Science, and PubMed/MEDLINE databases was performed for English-language publications up to July 2024. Eligible studies included reports of vascular injuries following COVID-19 vaccination. Results: Of the 1064 articles retrieved, 35 studies met the inclusion criteria. The majority of cases presented symptoms after receiving the first doses of Pfizer-BioNTech, Moderna, AstraZeneca, and Janssen vaccines. Diagnosed conditions included thrombotic thrombocytopenic purpura (TTP), immune thrombocytopenic purpura (ITP), vasculitis, and acquired hemophilia A. None of the patients tested positive for SARS-CoV-2 at the time of diagnosis. The most commonly affected sites were the lower extremities, with petechiae, purpura, and ecchymosis being the predominant manifestations. Conclusion: Our findings suggest a possible but unconfirmed association between COVID-19 vaccination and the development of vascular injuries, including petechiae, purpura, and ecchymosis. These symptoms may serve as early indicators of critical conditions requiring urgent medical intervention. Further research and postvaccination monitoring are necessary to establish causality and assess potential risk factors. © 2025 The Author(s). Health Science Reports published by Wiley Periodicals LLC.