Sánchez van Kammen, Mayte

Aguiar de Sousa, Diana

Poli, Sven

Cordonnier, Charlotte

Heldner, Mirjam R

van de Munckhof, Anita

Krzywicka, Katarzyna

van Haaps, Thijs

Ciccone, Alfonso

Middeldorp, Saskia

Levi, Marcel M

Scholz, Moritz J

Raposo, Nicolas

Kahnis, Robert

Kruyt, Nyika

Huet, Olivier

Sharma, Pankaj

Candelaresi, Paolo

Reiner, Peggy

Vieira, Ricardo

Acampora, Roberto

Kremer Hovinga, Johanna A

Kern, Rolf

Leker, Ronen

Coutts, Shelagh

Bal, Simerpreet

Sharma, Shyam S

Susen, Sophie

Cox, Thomas

Geeraerts, Thomas

Gattringer, Thomas

Bartsch, Thorsten

Silvis, Suzanne

Kleinig, Timothy J

Dizonno, Vanessa

Arslan, Yildiz

Hiltunen, Sini

Mansour, Maryam

Arauz, Antonio

Barboza, Miguel A

Field, Thalia S

Tsivgoulis, Georgios

Nagel, Simon

Lindgren, Erik

Tatlisumak, Turgut

Jood, Katarina

Putaala, Jukka

Ferro, Jose M

Arnold, Marcel

Coutinho, Jonathan M

Sharma, Aarti R

Elkady, Ahmed

Negro, Alberto

Günther, Albrecht

Gutschalk, Alexander

Schönenberger, Silvia

Buture, Alina

Murphy, Sean

Paiva Nunes, Ana

Tiede, Andreas

Puthuppallil Philip, Anemon

Mengel, Annerose

Medina, Antonio

Hellström Vogel, Åslög

Tawa, Audrey

Aujayeb, Avinash

Casolla, Barbara

Buck, Brian

Zanferrari, Carla

Garcia-Esperon, Carlos

Vayne, Caroline

Legault, Catherine

Pfrepper, Christian

Tracol, Clement

Soriano, Cristina

Guisado-Alonso, Daniel

Bougon, David

Zimatore, Domenico S

Michalski, Dominik

Blacquiere, Dylan

Johansson, Elias

Cuadrado-Godia, Elisa

De Maistre, Emmanuel

Carrera, Emmanuel

Vuillier, Fabrice

Bonneville, Fabrice

Giammello, Fabrizio

Bode, Felix J

Zimmerman, Julian

d'Onofrio, Florindo

Grillo, Francesco

Cotton, Francois

Caparros, François

Puy, Laurent

Maier, Frank

Gulli, Giosue

Frisullo, Giovanni

Polkinghorne, Gregory

Franchineau, Guillaume

Cangür, Hakan

Katzberg, Hans

Sibon, Igor

Baharoglu, Irem

Brar, Jaskiran

Payen, Jean-François

Burrow, Jim

Fernandes, João

Schouten, Judith

Althaus, Katharina

Garambois, Katia

Derex, Laurent

Humbertjean, Lisa

Lebrato Hernandez, Lucia

Kellermair, Lukas

Morin Martin, Mar

Petruzzellis, Marco

Cotelli, Maria

Dubois, Marie-Cécile

Carvalho, Marta

Wittstock, Matthias

Miranda, Miguel

Skjelland, Mona

Bandettini di Poggio, Monica

2021-09-28

IMPORTANCE: Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). OBJECTIVE: To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. EXPOSURES: Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. MAIN OUTCOMES AND MEASURES: Clinical characteristics and mortality rate. RESULTS: Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. CONCLUSIONS AND RELEVANCE: In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.

Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal.

Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany.

Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.

Department of Neurosciences and Cognition, Lille University Hospital, Lille, France.

Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy.

Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.

National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom.

Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Department of Neurology, Hadassah University Medical Center, Jerusalem, Israel.

Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada.

Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom.

Department of Hematology and Transfusion, Lille University Hospital, Lille, France.

Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.

Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France.

Department of Neurology, Medical University of Graz, Graz, Austria.

Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.

Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia.

Neurology Clinic, Medicana İzmir International Hospital, Izmir, Turkey.

Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.

Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran.

National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico.

Neurosciences Department, Hospital Dr R.A. Calderón Guardia, San José, Costa Rica.

Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada.

Second Department of Neurology in National, Kapodistrian University of Athens School of Medicine, Athens, Greece.

Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.

Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

Imperial College London School of Medicine, Imperial College London, London, United Kingdom.

Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia.

Department of Neuroradiology, Ospedale del Mare, Naples, Italy.

Department of Neurology, Jena University Hospital, Jena, Germany.

Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland.

UCD School of Medicine, University College Dublin, Dublin, Ireland.

School of Medicine, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.

Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.

Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.

Department of Neurology, Hamilton General Hospital, Hamilton, Ontario, Canada.

Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany.

Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.

Department of Internal Medicine, Skåne University Hospital, Lund, Sweden.

Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France.

Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom.

Stroke Unit, Hôpital Pasteur 2, URRIS - UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France.

Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada.

Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy.

Department of Neurology, John Hunter Hospital, Newcastle, Australia.

Department of Hematology and Hemostasis, Tours University Hospital, Tours, France.

Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada.

Division of Hemostaseology, Leipzig University Hospital, Leipzig, Germany.

Department of Neurology, CHU Rennes, Rennes, France.

Department of Neurology, Hospital General de Castellón, Castelló, Spain.

Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.

Department of Critical Care, Annecy Genevois Hospital, Annecy, France.

Department of Neuroradiology, Policlinico di Bari, Bari, Italy.

Department of Neurology, Leipzig University Hospital, Leipzig, Germany.

Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada.

Department Clinical Science, Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden.

Department of Neurology, University Hospital del Mar, Barcelona, Spain.

Department of Biological Haematology, CHU Dijon, Dijon, France.

Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.

Stroke Unit, University Hospital of Besancon, Besancon, France.

Department of Neuroradiology, Toulouse University Hospital, Toulouse, France.

Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.

Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany.

Department of Neurology, San Giuseppe Moscati Hospital, Avellino, Italy.

Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy.

Department of Radiology, Lyon University Hospital, Lyon, France.

Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany.

Department of Medicine, Ashford and St Peters Hospital NHS Foundation Trust, Surrey, United Kingdom.

Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Princess Alexandra Hospital, Brisbane, Australia.

Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France.

Department of Neurology, Hospital of the City of Wolfsburg, Wolfsburg, Germany.

Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada.

Department of Neurology, Bordeaux University Hospital, Bordeaux, France.

Department of Neurology, Haga Hospital, The Hague, the Netherlands.

Department of Neurology, Surrey Memorial Hospital, Surrey, British Columbia, Canada.

Department of Anesthesia and Critical Care, CHU Grenoble, Grenoble, France.

Department of Neurology, Royal Darwin Hospital, Tiwi, Australia.

Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden.

Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands.

Department of Neurology, Ulm University Hospital, Ulm, Germany.

Stroke Unit, University Hospital of Grenoble, Grenoble, France.

Department of Neurology, Hospices Civils de Lyon, Lyon, France.

Stroke Unit, University Hospital of Nancy, Nancy, France.

Department of Neurology, Virgen del Rocio University Hospital, Seville, Spain.

Department of Neurology, Johannes Kepler University Linz, Linz, Austria.

Department of Neurology, Hospital Complex of Toledo, Toledo, Spain.

Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy.

Department of Neurology, ASL Vallecamonica-Sebino, Breno, Italy.

Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France.

Department of Neurology, Centro Hospitalar Universitário de São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Department of Neurology, University Hospital Rostock, Rostock, Germany.

Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal.

Department of Neurology, Oslo University Hospital, Oslo, Norway.

Department of Neuroscience, Policlinic San Martino Hospital, Genoa, Italy.

Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.

Department of Neurology, Toulouse University Hospital, Toulouse, France.

Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.

UFR de Bio-médecine, Hospital de la Cavale Blanche, CHRU de Brest, Brest, France.

Institute of Cardiovascular Research, Royal Holloway University of London, London, United Kingdom.

Department of Neurology and Stroke, Cardarelli Hospital, Naples, Italy.

Department of Neurology, Lariboisière Hospital, Paris, France.

Department of Hematology, Universidade Federal do Cariri, Juazeiro do Norte, Brazil.

Department of Neurology, Ospedale del Mare, Naples, Italy.

Department of Neurology, Kempten Hospital, Kempten, Germany.

JAMA Neurol. 2021 Sep 28:e213619. doi: 10.1001/jamaneurol.2021.3619.

https://pubmed.ncbi.nlm.nih.gov/34581763/?otool=iaurydwlib

https://hdl.handle.net/10137/11925

Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia.

Journal Article

Publication