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Vaccine-induced immune thrombotic thrombocytopenia has been described after adenoviral-based vaccine administration for COVID-19. Similar to autoimmune heparin-induced thrombocytopenia (aHIT), there exists a potential for long-term persistence of anti-platelet factor 4 antibodies. The optimal follow up and thrombosis risk assessment of these patients will be challenging and will raise practical questions. This evokes a need for consultation and guidance.