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.
Question What are the clinical characteristics and outcomes of patients
with cerebral venous sinus thrombosis with thrombocytopenia syndrome
after SARS-CoV-2 vaccination? Findings In this cohort study of 116
patients with cerebral venous sinus thrombosis after SARS-CoV-2
vaccination, 78 (67.2%) had thrombosis with thrombocytopenia syndrome.
Patients with thrombosis with thrombocytopenia syndrome were frequently
comatose at presentation (24%) and often had intracerebral hemorrhage
(68%) and concomitant thromboembolism (36%), and 47% died during
hospitalization. Meaning Patients with cerebral venous sinus thrombosis
after SARS-CoV-2 vaccination who met criteria for thrombosis with
thrombocytopenia syndrome had a distinct clinical profile and high
mortality rate.
This cohort study describes the clinical characteristics and outcome of
patients with cerebral venous sinus thrombosis after SARS-CoV-2
vaccination with and without thrombosis with thrombocytopenia syndrome
