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The novel coronavirus SARS-CoV-2 has resulted in a global pandemic withworldwide 6-digital infection rates and thousands death tolls daily. Enormeouseffords are undertaken to achieve high coverage of immunization in order toreach herd immunity to stop spreading of SARS-CoV-2 infection. SeveralSARS-CoV-2 vaccines, based either on mRNA, viral vectors, or inactivatedSARS-CoV-2 virus have been approved and are being applied worldwide. However,recently increased numbers of normally very rare types of thromboses associatedwith thrombocytopenia have been reported in particular in the context of theadenoviral vector vaccine ChAdOx1 nCoV-19 from Astra Zeneca. While statisticalprevalence of these side effects seem to correlate with this particular vaccinetype, i.e. adenonoviral vector based vaccines, the exact molecular mechanismsare still not clear. The present review summarizes current data and hypothesesfor molecular and cellular mechanisms into one integrated hypothesis indicatingthat coagulopathies, including thromboses, thrombocytopenia and other relatedside effects are correlated to an interplay of the two components in thevaccine, i.e. the spike antigen and the adenoviral vector, with the innate andimmune system which under certain circumstances can imitate the picture of alimited COVID-19 pathological picture.

Coagulapathies after vaccination against SARS-CoV-2 may be derived from  a combination effect of SARS-CoV-2 spike protein and adenovirus  vector-triggered signaling pathways