TY - JOUR
T1 - Declining mortality of cerebral venous sinus thrombosis with thrombocytopenia after SARS-CoV-2 vaccination
AU - van de Munckhof, Anita
AU - Krzywicka, Katarzyna
AU - Aguiar de Sousa, Diana
AU - Sánchez van Kammen, Mayte
AU - Heldner, Mirjam R
AU - Jood, Katarina
AU - Lindgren, Erik
AU - Tatlisumak, Turgut
AU - Putaala, Jukka
AU - Kremer Hovinga, Johanna A
AU - Middeldorp, Saskia
AU - Levi, Marcel
AU - Arnold, Marcel
AU - Ferro, José M
AU - Coutinho, Jonathan M
N1 - Funding Information:
AM, KK, MSK, KJ, JAKH and ML have nothing to disclose. DAS reports travel support from Boehringer Ingelheim, advisory board participation for AstraZeneca, DSMB participation for the SECRET trial, and being a member of the ESO Executive Committee. MRH reports grants from the Swiss Heart Foundation and Bangerter Foundation, travel support from Bayer, and DSMB or advisory board participation for Amgen, and being a member of the ESO Board of Directors and of the ESO Education Committee. EL reports academic grants from the Swedish Neurological Society, Elsa and Gustav Lindh's Foundation, P‐O Ahl's Foundation and Rune and Ulla Amlöv's Foundation. TT has served/serves on scientific advisory boards for Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Inventiva, Portola Pharm and PHRI; has/has had research contracts with Bayer, Boehringer Ingelheim and Bristol Myers Squibb. JP reports grants paid to his institution from the Academy of Finland, Hospital District of Helsinki and Uusimaa, and Finnish Foundation for Cardiovascular Research, consulting fees from Boehringer‐Ingelheim, Bayer and Herantis Pharma, payment for honoraria, lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim, Bayer and Abbot, and stock ownership in Vital Signum. SM reports grants from Bayer paid to her institution, personal fees from Bayer paid to her institution, grants from Pfizer paid to her institution, personal fees from BMS/Pfizer paid to her institution, grants from Boehringer Ingelheim paid to her institution, personal fees from Boehringer Ingelheim paid to her institution, personal fees from Abbvie paid to her institution, personal fees from Portola/Alexion paid to her institution, grants from Daiichi Sankyo paid to her institution, and personal fees from Daiichi Sankyo paid to her institution outside the submitted work. MA reports honoraria for lectures from Bayer, AstraZeneca, Covidien and Medtronic, and honoraria for scientific advisory board participation from Amgen, Bayer, BMS, Daiichi Sankyo, Medtronic and Novartis. JMF reports fees and DSMB or advisory board participation for Boehringer Ingelheim and consulting fees from Bayer. JMC reports grants, paid to his institution from Boehringer Ingelheim and Bayer, and payments, paid to his institution for DSMB participation by Bayer. There were no other relationships or activities that could appear to have influenced the submitted work.
Publisher Copyright:
© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2022/1
Y1 - 2022/1
N2 - Background and purpose: High mortality rates have been reported in patients with cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) after vaccination with adenoviral vector SARS-CoV-2 vaccines. The aim of this study was to evaluate whether the mortality of patients with CVST-VITT has decreased over time. Methods: The EudraVigilance database of the European Medicines Agency was used to identify cases of CVST with concomitant thrombocytopenia occurring within 28 days of SARS-CoV-2 vaccination. Vaccines were grouped based on vaccine type (adenoviral or mRNA). Cases with CVST onset until 28 March were compared to cases after 28 March 2021, which was the day when the first scientific paper on VITT was published. Results: In total, 270 cases of CVST with thrombocytopenia were identified, of which 266 (99%) occurred after adenoviral vector SARS-CoV-2 vaccination (ChAdOx1 nCoV-19, n = 243; Ad26.COV2.S, n = 23). The reported mortality amongst adenoviral cases with onset up to 28 March 2021 was 47/99 (47%, 95% confidence interval 37%–58%) compared to 36/167 (22%, 95% confidence interval 16%–29%) in cases with onset after 28 March (p < 0.001). None of the four cases of CVST with thrombocytopenia occurring after mRNA vaccination died. Conclusion: The reported mortality of CVST with thrombocytopenia after vaccination with adenoviral vector-based SARS-CoV-2 vaccines has significantly decreased over time, which may indicate a beneficial effect of earlier recognition and/or improved treatment on outcome after VITT.
AB - Background and purpose: High mortality rates have been reported in patients with cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) after vaccination with adenoviral vector SARS-CoV-2 vaccines. The aim of this study was to evaluate whether the mortality of patients with CVST-VITT has decreased over time. Methods: The EudraVigilance database of the European Medicines Agency was used to identify cases of CVST with concomitant thrombocytopenia occurring within 28 days of SARS-CoV-2 vaccination. Vaccines were grouped based on vaccine type (adenoviral or mRNA). Cases with CVST onset until 28 March were compared to cases after 28 March 2021, which was the day when the first scientific paper on VITT was published. Results: In total, 270 cases of CVST with thrombocytopenia were identified, of which 266 (99%) occurred after adenoviral vector SARS-CoV-2 vaccination (ChAdOx1 nCoV-19, n = 243; Ad26.COV2.S, n = 23). The reported mortality amongst adenoviral cases with onset up to 28 March 2021 was 47/99 (47%, 95% confidence interval 37%–58%) compared to 36/167 (22%, 95% confidence interval 16%–29%) in cases with onset after 28 March (p < 0.001). None of the four cases of CVST with thrombocytopenia occurring after mRNA vaccination died. Conclusion: The reported mortality of CVST with thrombocytopenia after vaccination with adenoviral vector-based SARS-CoV-2 vaccines has significantly decreased over time, which may indicate a beneficial effect of earlier recognition and/or improved treatment on outcome after VITT.
KW - COVID-19 vaccines
KW - cerebral venous sinus thrombosis
KW - mortality
KW - sinus thrombosis, intracranial
KW - thrombocytopenia
UR - https://www.scopus.com/pages/publications/85115943005
UR - https://www.ncbi.nlm.nih.gov/pubmed/34536256
U2 - 10.1111/ene.15113
DO - 10.1111/ene.15113
M3 - Article
C2 - 34536256
SN - 1351-5101
VL - 29
SP - 339
EP - 344
JO - European journal of neurology
JF - European journal of neurology
IS - 1
ER -
SDG 3 Good Health and Well-being