학술논문
Management of cerebral venous thrombosis due to adenoviral covid-19 vaccination
Document Type
Author
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 M.; Coutinho, Jonathan M.; Arnold, Marcel; Poli, Sven; Heldner, Mirjam R.
Source
DEAL Annals of Neurology. 92(4):562-573
Subject
Language
English
ISSN
0364-5134
1531-8249
1531-8249
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.