8 In hospitalized patients with COVID, where circulating, prothrombotic antibodies that activate neutrophils, platelets, and endothelium have been identified, 9 orally administered fostamatinib reduced adverse events and showed a trend toward clinical benefit. 10 Although large, randomized trials are impractical in VITT given its low incidence, the FcγRIIA-dependent signaling mechanism leading to platelet activation in VITT identified by Greinacher et al provides strong rationale to consider SYK inhibition in the limited therapeutic armamentarium of clinicians treating VITT and perhaps other forms of autoantibody-mediated thrombosis.
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