Management of cerebral venous thrombosis due to adenoviral COVID-19 vaccination

• Author(s): Scutelnic, Adrian ; Krzywicka, Katarzyna ; Mbroh, Joshua ; van de Munckhof, Anita ; van Kammen, Mayte Sánchez ; de Sousa, Diana Aguiar ; Lindgren, Erik ; Jood, Katarina ; Günther, Albrecht ; Hiltunen, Sini ; Putaala, Jukka ; Tiede, Andreas ; Maier, Frank ; Kern, Rolf ; Bartsch, Thorsten ; Althaus, Katharina ; Ciccone, Alfonso ; Wiedmann, Markus ; Skjelland, Mona ; Medina, Antonio ; Cuadrado‐Godia, Elisa ; Cox, Thomas ; Aujayeb, Avinash ; Raposo, Nicolas ; Garambois, Katia ; Payen, Jean‐Francois ; Vuillier, Fabrice ; Franchineau, Guillaume ; Timsit, Serge ; Bougon, David ; Dubois, Marie‐Cécile ; Tawa, Audrey ; Tracol, Clement ; De Maistre, Emmanuel ; Bonneville, Fabrice ; Vayne, Caroline ; Mengel, Annerose ; Michalski, Dominik ; Pelz, Johann ; Wittstock, Matthias ; Bode, Felix ; Zimmermann, Julian ; Schouten, Judith ; Buture, Alina ; Murphy, Sean ; Palma, Vincenzo ; Negro, Alberto ; Gutschalk, Alexander ; Nagel, Simon ; Schoenenberger, Silvia ; Frisullo, Giovanni ; Zanferrari, Carla ; Grillo, Francesco ; Giammello, Fabrizio ; Martin, Mar Morin ; Cervera, Alvaro ; Burrow, Jim ; Esperon, Carlos Garcia ; Chew, Beng Lim Alvin ; Kleinig, Timothy J. ; Soriano, Cristina ; Zimatore, Domenico S. ; Petruzzellis, Marco ; Elkady, Ahmed ; Miranda, Miguel S. ; Fernandes, João ; Vogel, Åslög Hellström ; Johansson, Elias ; Philip, Anemon Puthuppallil ; Coutts, Shelagh B. ; Bal, Simerpreet ; Buck, Brian ; Legault, Catherine ; Blacquiere, Dylan ; Katzberg, Hans D. ; Field, Thalia S. ; Dizonno, Vanessa ; Gattringer, Thomas ; Jacobi, Christian ; Devroye, Annemie ; Lemmens, Robin ; Kristoffersen, Espen Saxhaug ; di Poggio, Monica Bandettini ; Ghiasian, Masoud ; Karapanayiotides, Theodoros ; Chatterton, Sophie ; Wronski, Miriam ; Ng, Karl ; Kahnis, Robert ; Geeraerts, Thomas ; Reiner, Peggy ; Cordonnier, Charlotte ; Middeldorp, Saskia ; Levi, Marcel ; van Gorp, Eric C. M. ; van de Beek, Diederik ; Brodard, Justine ; Kremer Hovinga, Johanna A. ; Kruip, Marieke J. H. A. ; Tatlisumak, Turgut ; Ferro, José ; Coutinho, Jonathan M. ; Arnold, Marcel ; Poli, Sven ; Heldner, Mirjam R.
• Date: 2022
• Persistent ID: http://hdl.handle.net/10451/54540
• Origin: Repositório da Universidade de Lisboa
• Document Type: Journal article
• Language: English
• Contributor(s): Repositório Científico de Acesso Aberto da ULisboa

Description

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;92:562-573.