Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Abstract

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.Fil: Pujol Lereis, Virginia Andrea. Fleni. Centro Integral de Neurología Vascular; Argentina.Fil: Nguyen, Thanh N. Boston University School of Medicine. Boston Medical Center. Department of Neurology; Estados Unidos. Boston University School of Medicine. Boston Medical Center. Department of Radiology; Estados Unidos.Fil: Qureshi, Muhammad M. Boston University School of Medicine. Boston Medical Center. Department of Radiology; Estados Unidos. Boston University School of Medicine. Boston Medical Center. Department of Radiation Oncology; Estados Unidos.Fil: Klein, Piers. Boston University School of Medicine. Boston Medical Center. Department of Neurology; Estados Unidos. Boston University School of Medicine. Boston Medical Center. Department of Radiology; Estados Unidos.Fil: Yamagami, Hiroshi. Osaka National Hospital. National Hospital Organization. Department of Stroke Neurology: Japón.Fil: Abdalkader, Mohamad. Boston University School of Medicine. Boston Medical Center. Department of Radiology; Estados Unidos.Fil: Mikulik, Robert. St. Anne's University Hospital and Faculty of Medicine. International Clinical Research Center. Department of Neurology; República Checa.Fil: Sathya, Anvitha. Boston University School of Medicine. Boston Medical Center. Department of Neurology; Estados Unidos. Boston University School of Medicine. Boston Medical Center. Department of Radiology; Estados Unidos.Fil: Mansour, Ossama Yassin. Alexandria University. Department of Neurology; Egipto.Fil: Czlonkowska, Anna. Institute of Psychiatry and Neurology. Department of Neurology; Polonia.Fil: Lo, Hannah. Boston University School of Medicine. Boston Medical Center. Department of Neurology; Estados Unidos. Boston University School of Medicine. Boston Medical Center. Department of Radiology; Estados Unidos.Fil: Field, Thalia S. University of British Columbia. Division of Neurology, Dept. Medicine; Canadá.Fil: Charidimou, Andreas. Boston University School of Medicine. Boston Medical Center. Department of Neurology; Estados Unidos.Fil: Banerjee, Soma. Imperial College Healthcare NHS Trust. Charing Cross Hospital. Department of Stroke Medicine; Reino Unido.Fil: Yaghi, Shadi. Brown University. Rhode Island Hospital. Department of Neurology; Estados Unidos.Fil: Siegler, James E. Cooper University. Department of Neurology; Estados Unidos.Fil: Sedova, Petra. St. Anne's University Hospital and Faculty of Medicine. International Clinical Research Center. Department of Neurology; República Checa.Fil: Kwan, Joseph. Imperial College Healthcare NHS Trust. Charing Cross Hospital. Department of Stroke Medicine; Reino Unido.Fil: Aguiar de Sousa, Diana. North Lisbon University Hospital Center. Hospital de Santa María. Department of Neurology; Portugal.Fil: Demeestere, Jelle. Leuven University Hospital. Neurology Department; Bélgica