The novel coronavirus SARS-CoV-2 has resulted in a global pandemic with worldwide 6-digital infection rates and thousands death tolls daily. Enormeous effords are undertaken to achieve high coverage of immunization in order to reach herd immunity to stop spreading of SARS-CoV-2 infection. Several SARS-CoV-2 vaccines, based either on mRNA, viral vectors, or inactivated SARS-CoV-2 virus have been approved and are being applied worldwide. However, recently increased numbers of normally very rare types of thromboses associated with thrombocytopenia have been reported in particular in the context of the adenoviral vector vaccine ChAdOx1 nCoV-19 from Astra Zeneca. While statistical prevalence of these side effects seem to correlate with this particular vaccine type, i.e. adenonoviral vector based vaccines, the exact molecular mechanisms are still not clear. The present review summarizes current data and hypotheses for molecular and cellular mechanisms into one integrated hypothesis indicating that coagulopathies, including thromboses, thrombocytopenia and other related side effects are correlated to an interplay of the two components in the vaccine, i.e. the spike antigen and the adenoviral vector, with the innate and immune system which under certain circumstances can imitate the picture of a limited COVID-19 pathological picture.
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