Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries

Anita van de Munckhof, Afshin Borhani-Haghighi, Sanjith Aaron, Katarzyna Krzywicka, Mayte S. nchez van Kammen, Charlotte Cordonnier, Timothy J. Kleinig, Thalia S. Field, Sven Poli, Robin Lemmens, Adrian Scutelnic, Erik Lindgren, Jiangang Duan, Y. ldız Arslan, Eric C. M. van Gorp, Johanna A. Kremer Hovinga, Albrecht Günther, Katarina Jood, Turgut Tatlisumak, Jukka PutaalaMirjam R. Heldner, Marcel Arnold, Diana Aguiar de Sousa, Mohammad Wasay, Antonio Arauz, Adriana Bastos Conforto, José M. Ferro, Jonathan M. Coutinho, Joshua Mbroh, Alfonso Ciccone, Matthias Wittstock, Julian Zimmermann, Felix J. Bode, Mona Skjelland, Vanessa Dizonno, Annemie Devroye, Sini Hiltunen, Marco Petruzzellis, Tamam Bakchoul, Marcel Levi, Saskia Middeldorp, Aarti R. Sharma, Abdoreza Ghoreishi, Ahmed Elkady, Alberto Negro, Alexander Gutschalk, Alina Buture, Alvaro Cervera, Ana Paiva Nunes, Ana Romina Montané Baños, Andreas Tiede, Anil M. Tuladhar, Annerose Mengel, Antonio Medina, Avinash Aujayeb, Balakrishnan Ramasamy, Barbara Casolla, Neil Spratt, Bentolhoda Ziaadini, Boby Varkey Maramattom, Brian Buck, Carlos Garcia-Esperon, Caroline Vayne, Christian Jacobi, Christian Pfrepper, Deepti Bal, Domenico Sergio Zimatore, Dominik Michalski, Dylan Blacquiere, Elias Johansson, Elisa Cuadrado-Godia, Elyar Sadeghi-Hokmabadi, Emmanuel Carrera, Emmanuel De Maistre, Espen Saxhaug Kristoffersen, Etrat Hooshmandi, Fabrice Bonneville, Fabrice Vuillier, Fabrizio Giammello, Florindo D’Onofrio, Georgios Tsivgoulis, Giosue Gulli, Hans Katzberg, Igor Sibon, Irem Baharoglu, Jaime Masjuan, João Fernandes, Johann Pelz, Jorge Octavio López Esparza, Judith Schouten, Karl Ng, Laurent Derex, Laurent Puy, Leila Poorsaadat, Lenise Valler, Letícia Januzi de Almeida Rocha, Luis Murillo-Bonilla, Lukas Kellermair, Mar Morin Martin, Maria Sofia Cotelli, Maria Hernandez Perez, Marialuisa Zedde, Mariana Carvalho Dias, Marta Carvalho, Masoud Ghiasian, Meenakshisundaram Umaiorubahan, Mehrdad Roozbeh, Michele Romoli, Miguel Miranda, Miriam Wronski, Mohammad Saadatnia, Monica Bandettini di Poggio, Mostafa Almasi-Dooghaee, Nahid Hoseininejad Mir, Nasli R. Ichaporia, Naveen Kumar Paramasivan, Nicolas Raposo, Nima Fadakar, Nyika Kruyt, Olivier Detante, Pankaj Sharma, Paolo Candelaresi, Pasquale Scoppettuolo, Peggy Reiner, P. N. Sylaja, Ravi Kumar Karunakaran, Ricardo Vieira, Rolf Kern, Rudy Goh, Sapna Erat Sreedharan, Seán Murphy, Serge Timsit, Shelagh Coutts, Shyam S. Sharma, Silvia Schoenenberger, Simon Nagel, Subhash Kaul, Theodoros Karapanayiotides, Thomas Gattringer, Thomas Mathew, Thorsten Bartsch, Vincenzo Palma, Zahra Mirzaasgari, Zohreh Zamani, Alireza Mirahmadizadeh, Alonso Gutierrez-Romero, Ivan Iván Valdes-Ferrer, Santa Elizabeth Ceballos-Liceaga, Ana Maria Santibañez-Copado

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20–37) versus 47 (IQR 32–58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11–40]) than in HICs (44/102 [43%, 95% CI 34–53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
Original languageEnglish
Pages (from-to)1112-1120
Number of pages9
JournalInternational journal of stroke
Volume18
Issue number9
Early online date2023
DOIs
Publication statusPublished - 1 Oct 2023

Keywords

  • COVID-19
  • CVST
  • VITT
  • global health
  • thrombosis
  • vaccination

Cite this