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 Putaala; Mirjam 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

doi:https://doi.org/10.1177/17474930231182901

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 journal › Article › Academic › peer-review

1 Citation (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 language	English
Pages (from-to)	1112-1120
Number of pages	9
Journal	International journal of stroke
Volume	18
Issue number	9
Early online date	2023
DOIs	https://doi.org/10.1177/17474930231182901
Publication status	Published - 1 Oct 2023

Keywords

COVID-19
CVST
VITT
global health
thrombosis
vaccination

Access to Document

https://doi.org/10.1177/17474930231182901

Cite this

van de Munckhof, A., Borhani-Haghighi, A., Aaron, S., Krzywicka, K., van Kammen, M. S. N., Cordonnier, C., Kleinig, T. J., Field, T. S., Poli, S., Lemmens, R., Scutelnic, A., Lindgren, E., Duan, J., Arslan, Y. L., van Gorp, E. C. M., Kremer Hovinga, J. A., Günther, A., Jood, K., Tatlisumak, T., ... Maria Santibañez-Copado, A. (2023). Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. International journal of stroke, 18(9), 1112-1120. https://doi.org/10.1177/17474930231182901

@article{9606c43578a0436eabee961259be128e,

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

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.",

keywords = "COVID-19, CVST, VITT, global health, thrombosis, vaccination",

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

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Netherlands Organization for Health Research and Development (ZonMw, grant 10430072110005), Dr CJ Vaillant Foundation, Hospital District of Helsinki and Uusimaa (grant TYH2022223). Publisher Copyright: {\textcopyright} 2023 World Stroke Organization.",

year = "2023",

month = oct,

day = "1",

doi = "https://doi.org/10.1177/17474930231182901",

language = "English",

volume = "18",

pages = "1112--1120",

journal = "International journal of stroke",

issn = "1747-4930",

publisher = "Wiley-Blackwell",

number = "9",

}

van de Munckhof, A, Borhani-Haghighi, A, Aaron, S, Krzywicka, K, van Kammen, MSN, Cordonnier, C, Kleinig, TJ, Field, TS, Poli, S, Lemmens, R, Scutelnic, A, Lindgren, E, Duan, J, Arslan, YL, van Gorp, ECM, Kremer Hovinga, JA, Günther, A, Jood, K, Tatlisumak, T, Putaala, J, Heldner, MR, Arnold, M, de Sousa, DA, Wasay, M, Arauz, A, Conforto, AB, Ferro, JM, Coutinho, JM, Mbroh, J, Ciccone, A, Wittstock, M, Zimmermann, J, Bode, FJ, Skjelland, M, Dizonno, V, Devroye, A, Hiltunen, S, Petruzzellis, M, Bakchoul, T, Levi, M , Middeldorp, S, Sharma, AR, Ghoreishi, A, Elkady, A, Negro, A, Gutschalk, A, Buture, A, Cervera, A, Paiva Nunes, A, Romina Montané Baños, A, Tiede, A, Tuladhar, AM, Mengel, A, Medina, A, Aujayeb, A, Ramasamy, B, Casolla, B, Spratt, N, Ziaadini, B, Varkey Maramattom, B, Buck, B, Garcia-Esperon, C, Vayne, C, Jacobi, C, Pfrepper, C, Bal, D, Sergio Zimatore, D, Michalski, D, Blacquiere, D, Johansson, E, Cuadrado-Godia, E, Sadeghi-Hokmabadi, E, Carrera, E, Maistre, ED, Saxhaug Kristoffersen, E, Hooshmandi, E, Bonneville, F, Vuillier, F, Giammello, F, D’Onofrio, F, Tsivgoulis, G, Gulli, G, Katzberg, H, Sibon, I, Baharoglu, I, Masjuan, J, Fernandes, J, Pelz, J, Octavio López Esparza, J, Schouten, J, Ng, K, Derex, L, Puy, L, Poorsaadat, L, Valler, L, Januzi de Almeida Rocha, L, Murillo-Bonilla, L, Kellermair, L, Morin Martin, M, Sofia Cotelli, M, Hernandez Perez, M, Zedde, M, Carvalho Dias, M, Carvalho, M, Ghiasian, M, Umaiorubahan, M, Roozbeh, M, Romoli, M, Miranda, M, Wronski, M, Saadatnia, M, Bandettini di Poggio, M, Almasi-Dooghaee, M, Hoseininejad Mir, N, Ichaporia, NR, Kumar Paramasivan, N, Raposo, N, Fadakar, N, Kruyt, N, Detante, O, Sharma, P, Candelaresi, P, Scoppettuolo, P, Reiner, P, Sylaja, PN, Kumar Karunakaran, R, Vieira, R, Kern, R, Goh, R, Erat Sreedharan, S, Murphy, S, Timsit, S, Coutts, S, Sharma, SS, Schoenenberger, S, Nagel, S, Kaul, S, Karapanayiotides, T, Gattringer, T, Mathew, T, Bartsch, T, Palma, V, Mirzaasgari, Z, Zamani, Z, Mirahmadizadeh, A, Gutierrez-Romero, A, Iván Valdes-Ferrer, I, Elizabeth Ceballos-Liceaga, S & Maria Santibañez-Copado, A 2023, 'Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries', International journal of stroke, vol. 18, no. 9, pp. 1112-1120. https://doi.org/10.1177/17474930231182901

TY - JOUR

T1 - Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries

AU - van de Munckhof, Anita

AU - Borhani-Haghighi, Afshin

AU - Aaron, Sanjith

AU - Krzywicka, Katarzyna

AU - van Kammen, Mayte S. nchez

AU - Cordonnier, Charlotte

AU - Kleinig, Timothy J.

AU - Field, Thalia S.

AU - Poli, Sven

AU - Lemmens, Robin

AU - Scutelnic, Adrian

AU - Lindgren, Erik

AU - Duan, Jiangang

AU - Arslan, Y. ldız

AU - van Gorp, Eric C. M.

AU - Kremer Hovinga, Johanna A.

AU - Günther, Albrecht

AU - Jood, Katarina

AU - Tatlisumak, Turgut

AU - Putaala, Jukka

AU - Heldner, Mirjam R.

AU - Arnold, Marcel

AU - de Sousa, Diana Aguiar

AU - Wasay, Mohammad

AU - Arauz, Antonio

AU - Conforto, Adriana Bastos

AU - Ferro, José M.

AU - Coutinho, Jonathan M.

AU - Mbroh, Joshua

AU - Ciccone, Alfonso

AU - Wittstock, Matthias

AU - Zimmermann, Julian

AU - Bode, Felix J.

AU - Skjelland, Mona

AU - Dizonno, Vanessa

AU - Devroye, Annemie

AU - Hiltunen, Sini

AU - Petruzzellis, Marco

AU - Bakchoul, Tamam

AU - Levi, Marcel

AU - Middeldorp, Saskia

AU - Sharma, Aarti R.

AU - Ghoreishi, Abdoreza

AU - Elkady, Ahmed

AU - Negro, Alberto

AU - Gutschalk, Alexander

AU - Buture, Alina

AU - Cervera, Alvaro

AU - Paiva Nunes, Ana

AU - Romina Montané Baños, Ana

AU - Tiede, Andreas

AU - Tuladhar, Anil M.

AU - Mengel, Annerose

AU - Medina, Antonio

AU - Aujayeb, Avinash

AU - Ramasamy, Balakrishnan

AU - Casolla, Barbara

AU - Spratt, Neil

AU - Ziaadini, Bentolhoda

AU - Varkey Maramattom, Boby

AU - Buck, Brian

AU - Garcia-Esperon, Carlos

AU - Vayne, Caroline

AU - Jacobi, Christian

AU - Pfrepper, Christian

AU - Bal, Deepti

AU - Sergio Zimatore, Domenico

AU - Michalski, Dominik

AU - Blacquiere, Dylan

AU - Johansson, Elias

AU - Cuadrado-Godia, Elisa

AU - Sadeghi-Hokmabadi, Elyar

AU - Carrera, Emmanuel

AU - Maistre, Emmanuel De

AU - Saxhaug Kristoffersen, Espen

AU - Hooshmandi, Etrat

AU - Bonneville, Fabrice

AU - Vuillier, Fabrice

AU - Giammello, Fabrizio

AU - D’Onofrio, Florindo

AU - Tsivgoulis, Georgios

AU - Gulli, Giosue

AU - Katzberg, Hans

AU - Sibon, Igor

AU - Baharoglu, Irem

AU - Masjuan, Jaime

AU - Fernandes, João

AU - Pelz, Johann

AU - Octavio López Esparza, Jorge

AU - Schouten, Judith

AU - Ng, Karl

AU - Derex, Laurent

AU - Puy, Laurent

AU - Poorsaadat, Leila

AU - Valler, Lenise

AU - Januzi de Almeida Rocha, Letícia

AU - Murillo-Bonilla, Luis

AU - Kellermair, Lukas

AU - Morin Martin, Mar

AU - Sofia Cotelli, Maria

AU - Hernandez Perez, Maria

AU - Zedde, Marialuisa

AU - Carvalho Dias, Mariana

AU - Carvalho, Marta

AU - Ghiasian, Masoud

AU - Umaiorubahan, Meenakshisundaram

AU - Roozbeh, Mehrdad

AU - Romoli, Michele

AU - Miranda, Miguel

AU - Wronski, Miriam

AU - Saadatnia, Mohammad

AU - Bandettini di Poggio, Monica

AU - Almasi-Dooghaee, Mostafa

AU - Hoseininejad Mir, Nahid

AU - Ichaporia, Nasli R.

AU - Kumar Paramasivan, Naveen

AU - Raposo, Nicolas

AU - Fadakar, Nima

AU - Kruyt, Nyika

AU - Detante, Olivier

AU - Sharma, Pankaj

AU - Candelaresi, Paolo

AU - Scoppettuolo, Pasquale

AU - Reiner, Peggy

AU - Sylaja, P. N.

AU - Kumar Karunakaran, Ravi

AU - Vieira, Ricardo

AU - Kern, Rolf

AU - Goh, Rudy

AU - Erat Sreedharan, Sapna

AU - Murphy, Seán

AU - Timsit, Serge

AU - Coutts, Shelagh

AU - Sharma, Shyam S.

AU - Schoenenberger, Silvia

AU - Nagel, Simon

AU - Kaul, Subhash

AU - Karapanayiotides, Theodoros

AU - Gattringer, Thomas

AU - Mathew, Thomas

AU - Bartsch, Thorsten

AU - Palma, Vincenzo

AU - Mirzaasgari, Zahra

AU - Zamani, Zohreh

AU - Mirahmadizadeh, Alireza

AU - Gutierrez-Romero, Alonso

AU - Iván Valdes-Ferrer, Ivan

AU - Elizabeth Ceballos-Liceaga, Santa

AU - Maria Santibañez-Copado, Ana

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Netherlands Organization for Health Research and Development (ZonMw, grant 10430072110005), Dr CJ Vaillant Foundation, Hospital District of Helsinki and Uusimaa (grant TYH2022223). Publisher Copyright: © 2023 World Stroke Organization.

PY - 2023/10/1

Y1 - 2023/10/1

N2 - 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.

AB - 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.

KW - COVID-19

KW - CVST

KW - VITT

KW - global health

KW - thrombosis

KW - vaccination

UR - http://www.scopus.com/inward/record.url?scp=85165315215&partnerID=8YFLogxK

U2 - https://doi.org/10.1177/17474930231182901

DO - https://doi.org/10.1177/17474930231182901

M3 - Article

C2 - 37277922

SN - 1747-4930

VL - 18

SP - 1112

EP - 1120

JO - International journal of stroke

JF - International journal of stroke

IS - 9

ER -

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

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