Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia
Por:
van Kammen, MS, de Sousa, DA, Poli, S, Cordonnier, C, Heldner, MR, van de Munckhof, A, Krzywicka, K, van Haaps, T, Ciccone, A, Middeldorp, S, Levi, MM, Hovinga, JAK, Silvis, S, Hiltunen, S, Mansour, M, Arauz, A, Barboza, MA, Field, TS, Tsivgoulis, G, Nagel, S, Lindgren, E, Tatlisumak, T, Jood, K, Putaala, J, Ferro, JM, Arnold, M, Coutinho, JM, Guisado-Alonso D., Cerebral Venous Sinus Thrombosis T
Publicada:
1 nov 2021
Ahead of Print:
1 sep 2021
Resumen:
Importance Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). Objective To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. Design, Setting, and Participants This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. Exposures Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. Main Outcomes and Measures Clinical characteristics and mortality rate. Results Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. Conclusions and Relevance In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
Question What are the clinical characteristics and outcomes of patients with cerebral venous sinus thrombosis with thrombocytopenia syndrome after SARS-CoV-2 vaccination? Findings In this cohort study of 116 patients with cerebral venous sinus thrombosis after SARS-CoV-2 vaccination, 78 (67.2%) had thrombosis with thrombocytopenia syndrome. Patients with thrombosis with thrombocytopenia syndrome were frequently comatose at presentation (24%) and often had intracerebral hemorrhage (68%) and concomitant thromboembolism (36%), and 47% died during hospitalization. Meaning Patients with cerebral venous sinus thrombosis after SARS-CoV-2 vaccination who met criteria for thrombosis with thrombocytopenia syndrome had a distinct clinical profile and high mortality rate.
This cohort study describes the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis after SARS-CoV-2 vaccination with and without thrombosis with thrombocytopenia syndrome.
Filiaciones:
van Kammen, MS:
Univ Amsterdam, Dept Neurol, Amsterdam Univ, Med Ctr, Amsterdam, Netherlands
de Sousa, DA:
Univ Lisbon, Ctr Hosp Univ Lisboa Norte, Hosp Santa Maria, Dept Neurosci & Mental Hlth, Lisbon, Portugal
Poli, S:
Eberhard Kark Univ, Dept Neurol & Stroke, Tubingen, Germany
Eberhard Karls Univ Tubingen, Hertie Inst Clin Brain Res, Tubingen, Germany
Cordonnier, C:
Lille Univ Hosp, Dept Neurosci & Cognit, Lille, France
Heldner, MR:
Univ Bern, Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland
van de Munckhof, A:
Univ Amsterdam, Dept Neurol, Amsterdam Univ, Med Ctr, Amsterdam, Netherlands
Krzywicka, K:
Univ Amsterdam, Dept Neurol, Amsterdam Univ, Med Ctr, Amsterdam, Netherlands
van Haaps, T:
Univ Amsterdam, Amsterdam Univ, Dept Internal Med, Med Ctr, Amsterdam, Netherlands
Ciccone, A:
Azienda Socio Sanitaria Terr Mantova, Dept Neurol, Carlo Poma Hosp, Mantua, Italy
Middeldorp, S:
Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Internal Med, Med Ctr, Nijmegen, Netherlands
Levi, MM:
UCL, Hosp Biomed Res Ctr, Natl Inst Hlth Res, London, England
Hovinga, JAK:
Univ Bern, Bern Univ Hosp, Dept Hematol, Inselspital, Bern, Switzerland
Silvis, S:
Albert Schweitzer Hosp, Dept Neurol, Dordrecht, Netherlands
Hiltunen, S:
Univ Helsinki, Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland
Mansour, M:
Hamadan Univ Med Sci, Sine Hosp, Hamadan, Hamadan, Iran
Arauz, A:
Natl Inst Neurol & Neurosurg Manuel Velasco Suare, Mexico City, DF, Mexico
Barboza, MA:
Hosp Dr RA Calderon Guardia, Neurosci Dept, San Jose, Costa Rica
Field, TS:
Univ British Columbia, Div Neurol, Vancouver Stroke Program, Vancouver, BC, Canada
Tsivgoulis, G:
Natl Kapodistrian Univ Athens, Dept Neurol 2, Sch Med, Athens, Greece
Nagel, S:
Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany
Lindgren, E:
Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden
Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden
Tatlisumak, T:
Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden
Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden
Jood, K:
Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden
Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden
Putaala, J:
Univ Helsinki, Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland
Ferro, JM:
Univ Lisbon, Ctr Hosp Univ Lisboa Norte, Hosp Santa Maria, Dept Neurosci & Mental Hlth, Lisbon, Portugal
Arnold, M:
Univ Bern, Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland
Coutinho, JM:
Univ Amsterdam, Dept Neurol, Amsterdam Univ, Med Ctr, Amsterdam, Netherlands
Guisado-Alonso D.:
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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