| 1. |
|
|
| 2. |
- Sánchez Van Kammen, Mayte, et al.
(författare)
-
Characteristics and Outcomes of Patients with Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia
- 2021
-
Ingår i: JAMA Neurology. - : American Medical Association. - 2168-6149 .- 2168-6157. ; 78:11, s. 1314-1323
-
Tidskriftsartikel (refereegranskat)abstract
- 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..
|
|
| 3. |
- Scutelnic, Adrian, et al.
(författare)
-
Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination.
- 2022
-
Ingår i: Annals of neurology. - : Wiley. - 1531-8249 .- 0364-5134. ; 92:4, s. 562-573
-
Tidskriftsartikel (refereegranskat)abstract
- 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.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.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).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.
|
|
| 4. |
- Van De Munckhof, Anita, et al.
(författare)
-
Outcomes of cerebral venous thrombosis due to vaccine-induced immune thrombotic thrombocytopenia after the acute phase
- 2022
-
Ingår i: Stroke. - : American Heart Association. - 0039-2499 .- 1524-4628. ; 53:10, s. 3206-3210
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization.Methods: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization).Results: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed).Conclusions: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
|
|
| 5. |
|
|
| 6. |
- Ferro-Vazquez, C., et al.
(författare)
-
Metal and organic matter immobilization in temperate podzols : a high resolution study
- 2014
-
Ingår i: Geoderma. - : Elsevier. - 0016-7061 .- 1872-6259. ; 217, s. 225-234
-
Tidskriftsartikel (refereegranskat)abstract
- Aluminium and Fe fractions were obtained in samples from two temperate podzols by selective extraction with NaOH (Al-n, Fe-n), Na-dithionite-citrate (Al-d, Fe-d), acid NH4-oxalate (Al-o, Fe-o) and Na-pyrophosphate (Al-p, Fe-p) following the traditional fractionation procedures, and also by the use of the chlorides of K (Al-K), La (Al-La) and Cu (Al-cu) as non-buffered extractants for Al. Carbon content was also determined in the Na-pyrophosphate extract (C-p). Soil sampling was done at high-resolution to allow a more detailed characterization of the vertical processes than the traditional sampling by whole soil horizons. Results showed that Al-p and Fe-p make a large proportion of the Alo and Fe-o meaning that organoaluminic complexes dominated in the "active" metal pool instead of inorganic compounds. The degree of metal saturation of soil organic matter (estimated by the (Al-p Fe-p)/C-p molar ratios) increases with depth, especially in the uppermost samples of spodic horizons (Bhs1) where it increases up to 0.1. Aluminium dominates in the adsorption positions of the organic matter in the spodic horizon (Fe-p/Al-p ratios <0.5), except in the Bhs1 horizon (ratios > 1), indicating that the immobilization of Fe containing complexes occurs 10-15 cm above that of Al The highly stable Al-OM complexes accounted on average for 60% of the organoaluminic associations (>70% in the Bhs horizons). The moderately stable complexes predominate in A horizons (57-77% in ACB1 and 37-48% in ACB2) and the largest proportions of low stability complexes were found in the uppermost samples of the spodic horizons (Bhs1) of both soils (9-21%), together with the highest Fep contents and a decrease in pH values. From a stepwise multiple regression model it is suggested that pH is the main variable accounting for the stability of Al-OM compounds together with C and organically bound Fe contents. It is suggested that the illuviation of unsaturated organic acids lower the pH in upper spodic horizons, leading to the complexation of metals from formerly precipitated organometallic complexes and/or leading to their redissolution, enabling their migration to deeper soil layers. Iron complexes would be less soluble at soil pH, resulting in a differentiation of an upper Fe-rich Bhs1 horizon and a lower Bhs2 Al-rich horizon. The depth variation in C accumulation was found to be related to the proportion of highly stable Al-OM fraction.
|
|
