학술논문
Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries.
Document Type
Article
Author
van de Munckhof, Anita; Borhani-Haghighi, Afshin; Aaron, Sanjith; Krzywicka, Katarzyna; van Kammen, Mayte Sánchez; Cordonnier, Charlotte; Kleinig, Timothy J; Field, Thalia S; Poli, Sven; Lemmens, Robin; Scutelnic, Adrian; Lindgren, Erik; Duan, Jiangang; Arslan, Yıldız; van Gorp, Eric CM; Kremer Hovinga, Johanna A; Günther, Albrecht; Jood, Katarina; Tatlisumak, Turgut; Putaala, Jukka
Source
Subject
*MIDDLE-income countries
*IDIOPATHIC thrombocytopenic purpura
*VENOUS thrombosis
*CRANIAL sinuses
*SINUS thrombosis
*INTRACRANIAL hemorrhage
*ADENOVIRUS diseases
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Language
ISSN
1747-4930
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. [ABSTRACT FROM AUTHOR]