Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination

Adrian Scutelnic, Katarzyna Krzywicka, Joshua Mbroh, Anita van de Munckhof, Mayte Sánchez van Kammen, Diana Aguiar de Sousa, Erik Lindgren, Katarina Jood, Albrecht Günther, Sini Hiltunen, Jukka Putaala, Andreas Tiede, Frank Maier, Rolf Kern, Thorsten Bartsch, Katharina Althaus, Alfonso Ciccone, Markus Wiedmann, Mona Skjelland, Antonio MedinaElisa Cuadrado-Godia, Thomas Cox, Avinash Aujayeb, Nicolas Raposo, Katia Garambois, Jean-Francois Payen, Fabrice Vuillier, Guillaume Franchineau, Serge Timsit, David Bougon, Marie-Cécile Dubois, Audrey Tawa, Clement Tracol, Emmanuel De Maistre, Fabrice Bonneville, Caroline Vayne, Annerose Mengel, Dominik Michalski, Johann Pelz, Matthias Wittstock, Felix Bode, Julian Zimmermann, Judith Schouten, Alina Buture, Sean Murphy, Vincenzo Palma, Alberto Negro, Alexander Gutschalk, Simon Nagel, Silvia Schoenenberger, Giovanni Frisullo, Carla Zanferrari, Francesco Grillo, Fabrizio Giammello, Mar Morin Martin, Alvaro Cervera, Jim Burrow, Carlos Garcia Esperon, Beng Lim Alvin Chew, Timothy J Kleinig, Cristina Soriano, Domenico S Zimatore, Marco Petruzzellis, Ahmed Elkady, Miguel S Miranda, João Fernandes, Åslög Hellström Vogel, Elias Johansson, Anemon Puthuppallil Philip, Shelagh B Coutts, Simerpreet Bal, Brian Buck, Catherine Legault, Dylan Blacquiere, Hans D Katzberg, Thalia S Field, Vanessa Dizonno, Thomas Gattringer, Christian Jacobi, Annemie Devroye, Robin Lemmens, Espen Saxhaug Kristoffersen, Monica Bandettini di Poggio, Masoud Ghiasian, Theodoros Karapanayiotides, Sophie Chatterton, Miriam Wronski, Karl Ng, Robert Kahnis, Thomas Geeraerts, Peggy Reiner, Charlotte Cordonnier, Saskia Middeldorp, Marcel Levi, Eric C M van Gorp, Diederik van de Beek, Justine Brodard, Johanna A Kremer Hovinga, Marieke J H A Kruip, Turgut Tatlisumak, José M Ferro, Jonathan M Coutinho, Marcel Arnold, Sven Poli, Mirjam R Heldner

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish
JournalAnnals of neurology
Early online date2022
DOIs
Publication statusE-pub ahead of print - 2022

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