tetano
Editor, Senior Moderator
Stroke
. 2022 Sep 9;101161STROKEAHA122039575.
doi: 10.1161/STROKEAHA.122.039575. Online ahead of print.
Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase
Anita van de Munckhof[SUP] 1 [/SUP], Erik Lindgren[SUP] 2 3 [/SUP], Timothy J Kleinig[SUP] 4 [/SUP], Thalia S Field[SUP] 5 [/SUP], Charlotte Cordonnier[SUP] 6 [/SUP], Katarzyna Krzywicka[SUP] 1 [/SUP], Sven Poli[SUP] 7 8 [/SUP], Mayte Sánchez van Kammen[SUP] 1 [/SUP], Afshin Borhani-Haghighi[SUP] 9 [/SUP], Robin Lemmens[SUP] 10 [/SUP], Adrian Scutelnic[SUP] 11 [/SUP], Alfonso Ciccone[SUP] 12 [/SUP], Thomas Gattringer[SUP] 13 [/SUP], Matthias Wittstock[SUP] 14 [/SUP], Vanessa Dizonno[SUP] 5 [/SUP], Annemie Devroye[SUP] 10 [/SUP], Ahmed Elkady[SUP] 15 [/SUP], Albrecht Günther[SUP] 16 [/SUP], Alvaro Cervera[SUP] 17 [/SUP], Annerose Mengel[SUP] 7 [/SUP], Beng Lim Alvin Chew[SUP] 18 [/SUP], Brian Buck[SUP] 19 [/SUP], Carla Zanferrari[SUP] 20 [/SUP], Carlos Garcia-Esperon[SUP] 18 [/SUP], Christian Jacobi[SUP] 21 [/SUP], Cristina Soriano[SUP] 22 [/SUP], Dominik Michalski[SUP] 23 [/SUP], Zohreh Zamani[SUP] 24 [/SUP], Dylan Blacquiere[SUP] 25 [/SUP], Elias Johansson[SUP] 26 [/SUP], Elisa Cuadrado-Godia[SUP] 27 [/SUP], Fabrice Vuillier[SUP] 28 [/SUP], Felix J Bode[SUP] 29 [/SUP], François Caparros[SUP] 6 [/SUP], Frank Maier[SUP] 30 [/SUP], Georgios Tsivgoulis[SUP] 31 [/SUP], Hans D Katzberg[SUP] 32 [/SUP], Jiangang Duan[SUP] 33 [/SUP], Jim Burrow[SUP] 34 [/SUP], Johann Pelz[SUP] 23 [/SUP], Joshua Mbroh[SUP] 7 8 [/SUP], Joyce Oen[SUP] 35 [/SUP], Judith Schouten[SUP] 36 [/SUP], Julian Zimmermann[SUP] 29 [/SUP], Karl Ng[SUP] 37 [/SUP], Katia Garambois[SUP] 38 [/SUP], Marco Petruzzellis[SUP] 39 [/SUP], Mariana Carvalho Dias[SUP] 40 [/SUP], Masoud Ghiasian[SUP] 41 [/SUP], Michele Romoli[SUP] 42 [/SUP], Miguel Miranda[SUP] 43 [/SUP], Miriam Wronski[SUP] 37 [/SUP], Mona Skjelland[SUP] 44 [/SUP], Mostafa Almasi-Dooghaee[SUP] 25 [/SUP], Pauline Cuisenier[SUP] 38 [/SUP], Seán Murphy[SUP] 45 [/SUP], Serge Timsit[SUP] 46 [/SUP], Shelagh B Coutts[SUP] 47 [/SUP], Silvia Schönenberger[SUP] 48 [/SUP], Simon Nagel[SUP] 48 [/SUP], Sini Hiltunen[SUP] 49 [/SUP], Sophie Chatterton[SUP] 37 [/SUP], Thomas Cox[SUP] 50 [/SUP], Thorsten Bartsch[SUP] 51 [/SUP], Vahid Shaygannejad[SUP] 52 53 [/SUP], Zahra Mirzaasgari[SUP] 54 [/SUP], Saskia Middeldorp[SUP] 55 [/SUP], Marcel M Levi[SUP] 56 57 [/SUP], Johanna A Kremer Hovinga[SUP] 58 [/SUP], Katarina Jood[SUP] 2 3 [/SUP], Turgut Tatlisumak[SUP] 2 3 49 [/SUP], Jukka Putaala[SUP] 49 [/SUP], Mirjam R Heldner[SUP] 11 [/SUP], Marcel Arnold[SUP] 11 [/SUP], Diana Aguiar de Sousa[SUP] 59 60 [/SUP], José M Ferro[SUP] 60 [/SUP], Jonathan M Coutinho[SUP] 1 [/SUP]
Affiliations
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.
Keywords: hospitalization; intracranial thrombosis; mortality; thrombocytopenia; vaccination; venous thrombosis.
. 2022 Sep 9;101161STROKEAHA122039575.
doi: 10.1161/STROKEAHA.122.039575. Online ahead of print.
Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase
Anita van de Munckhof[SUP] 1 [/SUP], Erik Lindgren[SUP] 2 3 [/SUP], Timothy J Kleinig[SUP] 4 [/SUP], Thalia S Field[SUP] 5 [/SUP], Charlotte Cordonnier[SUP] 6 [/SUP], Katarzyna Krzywicka[SUP] 1 [/SUP], Sven Poli[SUP] 7 8 [/SUP], Mayte Sánchez van Kammen[SUP] 1 [/SUP], Afshin Borhani-Haghighi[SUP] 9 [/SUP], Robin Lemmens[SUP] 10 [/SUP], Adrian Scutelnic[SUP] 11 [/SUP], Alfonso Ciccone[SUP] 12 [/SUP], Thomas Gattringer[SUP] 13 [/SUP], Matthias Wittstock[SUP] 14 [/SUP], Vanessa Dizonno[SUP] 5 [/SUP], Annemie Devroye[SUP] 10 [/SUP], Ahmed Elkady[SUP] 15 [/SUP], Albrecht Günther[SUP] 16 [/SUP], Alvaro Cervera[SUP] 17 [/SUP], Annerose Mengel[SUP] 7 [/SUP], Beng Lim Alvin Chew[SUP] 18 [/SUP], Brian Buck[SUP] 19 [/SUP], Carla Zanferrari[SUP] 20 [/SUP], Carlos Garcia-Esperon[SUP] 18 [/SUP], Christian Jacobi[SUP] 21 [/SUP], Cristina Soriano[SUP] 22 [/SUP], Dominik Michalski[SUP] 23 [/SUP], Zohreh Zamani[SUP] 24 [/SUP], Dylan Blacquiere[SUP] 25 [/SUP], Elias Johansson[SUP] 26 [/SUP], Elisa Cuadrado-Godia[SUP] 27 [/SUP], Fabrice Vuillier[SUP] 28 [/SUP], Felix J Bode[SUP] 29 [/SUP], François Caparros[SUP] 6 [/SUP], Frank Maier[SUP] 30 [/SUP], Georgios Tsivgoulis[SUP] 31 [/SUP], Hans D Katzberg[SUP] 32 [/SUP], Jiangang Duan[SUP] 33 [/SUP], Jim Burrow[SUP] 34 [/SUP], Johann Pelz[SUP] 23 [/SUP], Joshua Mbroh[SUP] 7 8 [/SUP], Joyce Oen[SUP] 35 [/SUP], Judith Schouten[SUP] 36 [/SUP], Julian Zimmermann[SUP] 29 [/SUP], Karl Ng[SUP] 37 [/SUP], Katia Garambois[SUP] 38 [/SUP], Marco Petruzzellis[SUP] 39 [/SUP], Mariana Carvalho Dias[SUP] 40 [/SUP], Masoud Ghiasian[SUP] 41 [/SUP], Michele Romoli[SUP] 42 [/SUP], Miguel Miranda[SUP] 43 [/SUP], Miriam Wronski[SUP] 37 [/SUP], Mona Skjelland[SUP] 44 [/SUP], Mostafa Almasi-Dooghaee[SUP] 25 [/SUP], Pauline Cuisenier[SUP] 38 [/SUP], Seán Murphy[SUP] 45 [/SUP], Serge Timsit[SUP] 46 [/SUP], Shelagh B Coutts[SUP] 47 [/SUP], Silvia Schönenberger[SUP] 48 [/SUP], Simon Nagel[SUP] 48 [/SUP], Sini Hiltunen[SUP] 49 [/SUP], Sophie Chatterton[SUP] 37 [/SUP], Thomas Cox[SUP] 50 [/SUP], Thorsten Bartsch[SUP] 51 [/SUP], Vahid Shaygannejad[SUP] 52 53 [/SUP], Zahra Mirzaasgari[SUP] 54 [/SUP], Saskia Middeldorp[SUP] 55 [/SUP], Marcel M Levi[SUP] 56 57 [/SUP], Johanna A Kremer Hovinga[SUP] 58 [/SUP], Katarina Jood[SUP] 2 3 [/SUP], Turgut Tatlisumak[SUP] 2 3 49 [/SUP], Jukka Putaala[SUP] 49 [/SUP], Mirjam R Heldner[SUP] 11 [/SUP], Marcel Arnold[SUP] 11 [/SUP], Diana Aguiar de Sousa[SUP] 59 60 [/SUP], José M Ferro[SUP] 60 [/SUP], Jonathan M Coutinho[SUP] 1 [/SUP]
Affiliations
- PMID: 36082668
- DOI: 10.1161/STROKEAHA.122.039575
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.
Keywords: hospitalization; intracranial thrombosis; mortality; thrombocytopenia; vaccination; venous thrombosis.