Characteristics and Outcomes of Patients with Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia

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Sánchez Van Kammen, MayteDepartment of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands (author)

Characteristics and Outcomes of Patients with Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia

Article/chapterEnglish2021

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American Medical Association,2021
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LIBRIS-ID:oai:DiVA.org:umu-191149
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-191149URI
https://doi.org/10.1001/jamaneurol.2021.3619DOI
https://gup.ub.gu.se/publication/310518URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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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..

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Infektionsmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Infectious Medicine hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Neurologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Neurology hsv//eng
diagnosis
Neurosciences & Neurology

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Aguiar De Sousa, DianaDepartment of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal (author)
Poli, SvenDepartment of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany (author)
Cordonnier, CharlotteDepartment of Neurosciences and Cognition, Lille University Hospital, Lille, France (author)
Heldner, Mirjam R.Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (author)
Van De Munckhof, AnitaDepartment of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands (author)
Krzywicka, KatarzynaDepartment of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands (author)
Van Haaps, ThijsDepartment of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands (author)
Ciccone, AlfonsoDepartment of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy (author)
Middeldorp, SaskiaDepartment of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands (author)
Levi, Marcel M.National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, United Kingdom (author)
Kremer Hovinga, Johanna A.Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (author)
Silvis, SuzanneDepartment of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands (author)
Hiltunen, SiniDepartment of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (author)
Mansour, MaryamSina Hospital, Hamadan University of Medical Science, Hamadan, Iran (author)
Arauz, AntonioNational Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico (author)
Barboza, Miguel A.Neurosciences Department, Hospital Dr R.A. Calderón Guardia, San José, Costa Rica (author)
Field, Thalia S.Division of Neurology, University of British Columbia, Vancouver Stroke Program, BC, Vancouver, Canada (author)
Tsivgoulis, GeorgiosSecond Department of Neurology in National, Kapodistrian University of Athens, School of Medicine, Athens, Greece (author)
Nagel, SimonDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany (author)
Lindgren, Erik,1993Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xliere (author)
Tatlisumak, TurgutGothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xtatlt (author)
Jood, Katarina,1966Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xjooka (author)
Putaala, JukkaDepartment of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (author)
Ferro, Jose M.Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal (author)
Arnold, MarcelDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (author)
Coutinho, Jonathan M.Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands (author)
Sharma, Aarti R.Imperial College London School of Medicine, Imperial College London, London, United Kingdom (author)
Elkady, AhmedDepartment of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia (author)
Negro, AlbertoDepartment of Neuroradiology, Ospedale Del Mare, Naples, Italy (author)
Günther, AlbrechtDepartment of Neurology, Jena University Hospital, Jena, Germany (author)
Gutschalk, AlexanderDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany (author)
Schönenberger, SilviaDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany (author)
Buture, AlinaAcute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland (author)
Murphy, SeanAcute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland; UCD School of Medicine, University College Dublin, Dublin, Ireland; School of Medicine, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland (author)
Paiva Nunes, AnaDepartment of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal (author)
Tiede, AndreasClinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany (author)
Puthuppallil Philip, AnemonDepartment of Neurology, Hamilton General Hospital, ON, Hamilton, Canada (author)
Mengel, AnneroseDepartment of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany (author)
Medina, AntonioDepartment of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain (author)
Hellström Vogel, ÅslögDepartment of Internal Medicine, Skåne University Hospital, Lund, Sweden (author)
Tawa, AudreyDepartment of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France (author)
Aujayeb, AvinashRespiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom (author)
Casolla, BarbaraRespiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom; Stroke Unit, Hôpital Pasteur 2, URRIS - UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France (author)
Buck, BrianDivision of Neurology, University of Alberta Hospital, AL, Edmonton, Canada (author)
Zanferrari, CarlaDepartment of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy (author)
Garcia-Esperon, CarlosDepartment of Neurology, John Hunter Hospital, Newcastle, Australia (author)
Vayne, CarolineDepartment of Hematology and Hemostasis, Tours University Hospital, Tours, France (author)
Legault, CatherineDepartment of Neurology and Neurosurgery, McGill University Health Centre, QC, Montreal, Canada (author)
Pfrepper, ChristianDivision of Hemostaseology, Leipzig University Hospital, Leipzig, Germany (author)
Tracol, ClementDepartment of Neurology, CHU Rennes, Rennes, France (author)
Soriano, CristinaDepartment of Neurology, Hospital General de Castellón, Castelló, Spain (author)
Guisado-Alonso, DanielDepartment of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (author)
Bougon, DavidDepartment of Critical Care, Annecy Genevois Hospital, Annecy, France (author)
Zimatore, Domenico S.Department of Neuroradiology, Policlinico di Bari, Bari, Italy (author)
Michalski, DominikDepartment of Neurology, Leipzig University Hospital, Leipzig, Germany (author)
Blacquiere, DylanDivision of Neurology, Ottawa Hospital, ON, Ottawa, Canada (author)
Johansson, EliasUmeå universitet,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM),Neurovetenskaper(Swepub:umu)elsjon02 (author)
Cuadrado-Godia, ElisaDepartment of Neurology, University Hospital Del Mar, Barcelona, Spain (author)
De Maistre, EmmanuelDepartment of Biological Haematology, CHU Dijon, Dijon, France (author)
Carrera, EmmanuelDepartment of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland (author)
Vuillier, FabriceStroke Unit, University Hospital of Besancon, Besancon, France (author)
Bonneville, FabriceDepartment of Neuroradiology, Toulouse University Hospital, Toulouse, France (author)
Giammello, FabrizioTranslational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy (author)
Bode, Felix J.Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany (author)
Zimmerman, JulianDepartment of Neurology, Universitätsklinikum Bonn, Bonn, Germany (author)
D'Onofrio, FlorindoDepartment of Neurology, San Giuseppe Moscati Hospital, Avellino, Italy (author)
Grillo, FrancescoStroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy (author)
Cotton, FrancoisDepartment of Radiology, Lyon University Hospital, Lyon, France (author)
Caparros, FrançoisDepartment of Neurosciences and Cognition, Lille University Hospital, Lille, France (author)
Puy, LaurentDepartment of Neurosciences and Cognition, Lille University Hospital, Lille, France (author)
Maier, FrankDepartment of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany (author)
Gulli, GiosueDepartment of Medicine, Ashford and St Peters Hospital NHS Foundation Trust, Surrey, United Kingdom (author)
Frisullo, GiovanniDepartment of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (author)
Polkinghorne, GregoryPrincess Alexandra Hospital, Brisbane, Australia (author)
Franchineau, GuillaumeDepartment of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France (author)
Cangür, HakanDepartment of Neurology, Hospital of the City of Wolfsburg, Wolfsburg, Germany (author)
Katzberg, HansDepartment of Neuromuscular Medicine, Toronto General Hospital, ON, Toronto, Canada (author)
Sibon, IgorDepartment of Neurology, Bordeaux University Hospital, Bordeaux, France (author)
Baharoglu, IremDepartment of Neurology, Haga Hospital, The Hague, Netherlands (author)
Brar, JaskiranDepartment of Neurology, Surrey Memorial Hospital, BC, Surrey, Canada (author)
Payen, Jean-FrançoisDepartment of Anesthesia and Critical Care, CHU Grenoble, Grenoble, France (author)
Burrow, JimDepartment of Neurology, Royal Darwin Hospital, Tiwi, Australia (author)
Fernandes, JoãoDepartment of Neurology, Norra Alvsborgs Länssjukhus, Trollhattan, Sweden (author)
Schouten, JudithDepartment of Neurology, Rijnstate Hospital Arnhem, Arnhem, Netherlands (author)
Althaus, KatharinaDepartment of Neurology, Ulm University Hospital, Ulm, Germany (author)
Garambois, KatiaStroke Unit, University Hospital of Grenoble, Grenoble, France (author)
Derex, LaurentDepartment of Neurology, Hospices Civils de Lyon, Lyon, France (author)
Humbertjean, LisaStroke Unit, University Hospital of Nancy, Nancy, France (author)
Lebrato Hernandez, LuciaDepartment of Neurology, Virgen Del Rocio University Hospital, Seville, Spain (author)
Kellermair, LukasDepartment of Neurology, Johannes Kepler University Linz, Linz, Austria (author)
Morin Martin, MarDepartment of Neurology, Hospital Complex of Toledo, Toledo, Spain (author)
Petruzzellis, MarcoDepartment of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy (author)
Cotelli, MariaDepartment of Neurology, ASL Vallecamonica-Sebino, Breno, Italy (author)
Dubois, Marie-CécileDepartment of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France (author)
Carvalho, MartaDepartment of Neurology, Centro Hospitalar Universitário de São João, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal (author)
Wittstock, MatthiasDepartment of Neurology, University Hospital Rostock, Rostock, Germany (author)
Miranda, MiguelDepartment of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal (author)
Skjelland, MonaDepartment of Neurology, Oslo University Hospital, Oslo, Norway (author)
Bandettini Di Poggio, MonicaDepartment of Neuroscience, Policlinic San Martino Hospital, Genoa, Italy (author)
Scholz, Moritz J.Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany (author)
Raposo, NicolasDepartment of Neurology, Toulouse University Hospital, Toulouse, France (author)
Kahnis, RobertDepartment of Neurology, Toulouse University Hospital, Toulouse, France (author)
Kruyt, NyikaDepartment of Neurology, Leiden University Medical Centre, Leiden, Netherlands (author)
Huet, OlivierUFR de Bio-médecine, Hospital de la Cavale Blanche, CHRU de Brest, Brest, France (author)
Sharma, PankajInstitute of Cardiovascular Research, Royal Holloway University of London, London, United Kingdom (author)
Candelaresi, PaoloDepartment of Neurology and Stroke, Cardarelli Hospital, Naples, Italy (author)
Reiner, PeggyDepartment of Neurology, Lariboisière Hospital, Paris, France (author)
Vieira, RicardoDepartment of Hematology, Universidade Federal Do Cariri, Juazeiro do Norte, Brazil (author)
Acampora, RobertoDepartment of Neurology, Ospedale Del Mare, Naples, Italy (author)
Kern, RolfDepartment of Neurology, Kempten Hospital, Kempten, Germany (author)
Leker, RonenDepartment of Neurology, Hadassah University Medical Center, Jerusalem, Israel (author)
Coutts, ShelaghDepartment of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, AL, Calgary, Canada (author)
Bal, SimerpreetDepartment of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, AL, Calgary, Canada (author)
Sharma, Shyam S.Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom (author)
Susen, SophieDepartment of Hematology and Transfusion, Lille University Hospital, Lille, France (author)
Cox, ThomasDepartment of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (author)
Geeraerts, ThomasDepartment of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France (author)
Gattringer, ThomasDepartment of Neurology, Medical University of Graz, Graz, Austria (author)
Bartsch, ThorstenDepartment of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany (author)
Kleinig, Timothy J.Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia (author)
Dizonno, VanessaDivision of Neurology, University of British Columbia, Vancouver Stroke Program, BC, Vancouver, Canada (author)
Arslan, YildizNeurology Clinic, Medicana İzmir International Hospital, Izmir, Turkey (author)
Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NetherlandsDepartment of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal (creator_code:org_t)

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In:JAMA Neurology: American Medical Association78:11, s. 1314-13232168-61492168-6157

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By the author/editor: Sánchez Van Kamm ...; Aguiar De Sousa, ...; Poli, Sven; Cordonnier, Char ...; Heldner, Mirjam ...; Van De Munckhof, ...; show more...; Krzywicka, Katar ...; Van Haaps, Thijs; Ciccone, Alfonso; Middeldorp, Sask ...; Levi, Marcel M.; Kremer Hovinga, ...; Silvis, Suzanne; Hiltunen, Sini; Mansour, Maryam; Arauz, Antonio; Barboza, Miguel ...; Field, Thalia S.; Tsivgoulis, Geor ...; Nagel, Simon; Lindgren, Erik, ...; Tatlisumak, Turg ...; Jood, Katarina, ...; Putaala, Jukka; Ferro, Jose M.; Arnold, Marcel; Coutinho, Jonath ...; Sharma, Aarti R.; Elkady, Ahmed; Negro, Alberto; Günther, Albrech ...; Gutschalk, Alexa ...; Schönenberger, S ...; Buture, Alina; Murphy, Sean; Paiva Nunes, Ana; Tiede, Andreas; Puthuppallil Phi ...; Mengel, Annerose; Medina, Antonio; Hellström Vogel, ...; Tawa, Audrey; Aujayeb, Avinash; Casolla, Barbara; Buck, Brian; Zanferrari, Carl ...; Garcia-Esperon, ...; Vayne, Caroline; Legault, Catheri ...; Pfrepper, Christ ...; Tracol, Clement; Soriano, Cristin ...; Guisado-Alonso, ...; Bougon, David; Zimatore, Domeni ...; Michalski, Domin ...; Blacquiere, Dyla ...; Johansson, Elias; Cuadrado-Godia, ...; De Maistre, Emma ...; Carrera, Emmanue ...; Vuillier, Fabric ...; Bonneville, Fabr ...; Giammello, Fabri ...; Bode, Felix J.; Zimmerman, Julia ...; D'Onofrio, Flori ...; Grillo, Francesc ...; Cotton, Francois; Caparros, Franço ...; Puy, Laurent; Maier, Frank; Gulli, Giosue; Frisullo, Giovan ...; Polkinghorne, Gr ...; Franchineau, Gui ...; Cangür, Hakan; Katzberg, Hans; Sibon, Igor; Baharoglu, Irem; Brar, Jaskiran; Payen, Jean-Fran ...; Burrow, Jim; Fernandes, João; Schouten, Judith; Althaus, Kathari ...; Garambois, Katia; Derex, Laurent; Humbertjean, Lis ...; Lebrato Hernande ...; Kellermair, Luka ...; Morin Martin, Ma ...; Petruzzellis, Ma ...; Cotelli, Maria; Dubois, Marie-Cé ...; Carvalho, Marta; Wittstock, Matth ...; Miranda, Miguel; Skjelland, Mona; Bandettini Di Po ...; Scholz, Moritz J ...; Raposo, Nicolas; Kahnis, Robert; Kruyt, Nyika; Huet, Olivier; Sharma, Pankaj; Candelaresi, Pao ...; Reiner, Peggy; Vieira, Ricardo; Acampora, Robert ...; Kern, Rolf; Leker, Ronen; Coutts, Shelagh; Bal, Simerpreet; Sharma, Shyam S.; Susen, Sophie; Cox, Thomas; Geeraerts, Thoma ...; Gattringer, Thom ...; Bartsch, Thorste ...; Kleinig, Timothy ...; Dizonno, Vanessa; Arslan, Yildiz; show less...

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