Dataset Information

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination.

ABSTRACT:

Objective

Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality.

Methods

We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis.

Results

Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16-1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06-0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24-2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74-6.54).

Conclusions

In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. ANN NEUROL 2022;92:562-573.

SUBMITTER: Scutelnic A

PROVIDER: S-EPMC9349982 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination.

Scutelnic Adrian A Krzywicka Katarzyna K Mbroh Joshua J van de Munckhof Anita A van Kammen Mayte Sánchez MS de Sousa Diana Aguiar DA Lindgren Erik E Jood Katarina K Günther Albrecht A Hiltunen Sini S Putaala Jukka J Tiede Andreas A Maier Frank F Kern Rolf R Bartsch Thorsten T Althaus Katharina K Ciccone Alfonso A Wiedmann Markus M Skjelland Mona M Medina Antonio A Cuadrado-Godia Elisa E Cox Thomas T Aujayeb Avinash A Raposo Nicolas N Garambois Katia K Payen Jean-Francois JF Vuillier Fabrice F Franchineau Guillaume G Timsit Serge S Bougon David D Dubois Marie-Cécile MC Tawa Audrey A Tracol Clement C De Maistre Emmanuel E Bonneville Fabrice F Vayne Caroline C Mengel Annerose A Michalski Dominik D Pelz Johann J Wittstock Matthias M Bode Felix F Zimmermann Julian J Schouten Judith J Buture Alina A Murphy Sean S Palma Vincenzo V Negro Alberto A Gutschalk Alexander A Nagel Simon S Schoenenberger Silvia S Frisullo Giovanni G Zanferrari Carla C Grillo Francesco F Giammello Fabrizio F Martin Mar Morin MM Cervera Alvaro A Burrow Jim J Esperon Carlos Garcia CG Chew Beng Lim Alvin BLA Kleinig Timothy J TJ Soriano Cristina C Zimatore Domenico S DS Petruzzellis Marco M Elkady Ahmed A Miranda Miguel S MS Fernandes João J Vogel Åslög Hellström ÅH Johansson Elias E Philip Anemon Puthuppallil AP Coutts Shelagh B SB Bal Simerpreet S Buck Brian B Legault Catherine C Blacquiere Dylan D Katzberg Hans D HD Field Thalia S TS Dizonno Vanessa V Gattringer Thomas T Jacobi Christian C Devroye Annemie A Lemmens Robin R Kristoffersen Espen Saxhaug ES di Poggio Monica Bandettini MB Ghiasian Masoud M Karapanayiotides Theodoros T Chatterton Sophie S Wronski Miriam M Ng Karl K Kahnis Robert R Geeraerts Thomas T Reiner Peggy P Cordonnier Charlotte C Middeldorp Saskia S Levi Marcel M van Gorp Eric C M ECM van de Beek Diederik D Brodard Justine J Kremer Hovinga Johanna A JA Kruip Marieke J H A MJHA Tatlisumak Turgut T Ferro José M JM Coutinho Jonathan M JM Arnold Marcel M Poli Sven S Heldner Mirjam R MR

Annals of neurology 20220704 4

<h4>Objective</h4>Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to th ...[more]

PMID: 35689346

Similar Datasets

Project description:BackgroundA new syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) has emerged as a rare side-effect of vaccination against COVID-19. Cerebral venous thrombosis is the most common manifestation of this syndrome but, to our knowledge, has not previously been described in detail. We aimed to document the features of post-vaccination cerebral venous thrombosis with and without VITT and to assess whether VITT is associated with poorer outcomes.MethodsFor this multicentre cohort study, clinicians were asked to submit all cases in which COVID-19 vaccination preceded the onset of cerebral venous thrombosis, regardless of the type of vaccine, interval between vaccine and onset of cerebral venous thrombosis symptoms, or blood test results. We collected clinical characteristics, laboratory results (including the results of tests for anti-platelet factor 4 antibodies where available), and radiological features at hospital admission of patients with cerebral venous thrombosis after vaccination against COVID-19, with no exclusion criteria. We defined cerebral venous thrombosis cases as VITT-associated if the lowest platelet count recorded during admission was below 150 × 109 per L and, if the D-dimer was measured, the highest value recorded was greater than 2000 μg/L. We compared the VITT and non-VITT groups for the proportion of patients who had died or were dependent on others to help them with their activities of daily living (modified Rankin score 3-6) at the end of hospital admission (the primary outcome of the study). The VITT group were also compared with a large cohort of patients with cerebral venous thrombosis described in the International Study on Cerebral Vein and Dural Sinus Thrombosis.FindingsBetween April 1 and May 20, 2021, we received data on 99 patients from collaborators in 43 hospitals across the UK. Four patients were excluded because they did not have definitive evidence of cerebral venous thrombosis on imaging. Of the remaining 95 patients, 70 had VITT and 25 did not. The median age of the VITT group (47 years, IQR 32-55) was lower than in the non-VITT group (57 years; 41-62; p=0·0045). Patients with VITT-associated cerebral venous thrombosis had more intracranial veins thrombosed (median three, IQR 2-4) than non-VITT patients (two, 2-3; p=0·041) and more frequently had extracranial thrombosis (31 [44%] of 70 patients) compared with non-VITT patients (one [4%] of 25 patients; p=0·0003). The primary outcome of death or dependency occurred more frequently in patients with VITT-associated cerebral venous thrombosis (33 [47%] of 70 patients) compared with the non-VITT control group (four [16%] of 25 patients; p=0·0061). This adverse outcome was less frequent in patients with VITT who received non-heparin anticoagulants (18 [36%] of 50 patients) compared with those who did not (15 [75%] of 20 patients; p=0·0031), and in those who received intravenous immunoglobulin (22 [40%] of 55 patients) compared with those who did not (11 [73%] of 15 patients; p=0·022).InterpretationCerebral venous thrombosis is more severe in the context of VITT. Non-heparin anticoagulants and immunoglobulin treatment might improve outcomes of VITT-associated cerebral venous thrombosis. Since existing criteria excluded some patients with otherwise typical VITT-associated cerebral venous thrombosis, we propose new diagnostic criteria that are more appropriate.FundingNone.

Dataset Information

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination.

Objective

Methods

Results

Conclusions

Publications

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets