Management of Cerebral Venous Thrombosis Due to Adenoviral COVID‐19 Vaccination
Authors: Scutelnic Adrian , Krzywicka Katarzyna , Mbroh Joshua , van de Munckhof Anita , van Kammen Mayte Sánchez , de Sousa Diana Aguiar , Lindgren Erik , Jood Katarina , Günther Albrecht , Hiltunen Sini , Putaala Jukka , Tiede Andreas , Maier Frank , Kern Rolf , Bartsch Thorsten , Althaus Katharina , Ciccone Alfonso , Wiedmann Markus , Skjelland Mona , Medina Antonio , Cuadrado‐Godia Elisa , Cox Thomas , Aujayeb Avinash , Raposo Nicolas , Garambois Katia , Payen Jean‐Francois , Vuillier Fabrice , Franchineau Guillaume , Timsit Serge , Bougon David , Dubois Marie‐Cécile , Tawa Audrey , Tracol Clement , De Maistre Emmanuel , Bonneville Fabrice , Vayne Caroline , Mengel Annerose , Michalski Dominik , Pelz Johann , Wittstock Matthias , Bode Felix , Zimmermann Julian , Schouten Judith , Buture Alina , Murphy Sean , Palma Vincenzo , Negro Alberto , Gutschalk Alexander , Nagel Simon , Schoenenberger Silvia , Frisullo Giovanni , Zanferrari Carla , Grillo Francesco , Giammello Fabrizio , Martin Mar Morin , Cervera Alvaro , Burrow Jim , Esperon Carlos Garcia , Chew Beng Lim Alvin , Kleinig Timothy J. , Soriano Cristina , Zimatore Domenico S. , Petruzzellis Marco , Elkady Ahmed , Miranda Miguel S. , Fernandes João , Vogel Åslög Hellström , Johansson Elias , Philip Anemon Puthuppallil , Coutts Shelagh B. , Bal Simerpreet , Buck Brian , Legault Catherine , Blacquiere Dylan , Katzberg Hans D. , Field Thalia S. , Dizonno Vanessa , Gattringer Thomas , Jacobi Christian , Devroye Annemie , Lemmens Robin , Kristoffersen Espen Saxhaug , di Poggio Monica Bandettini , Ghiasian Masoud , Karapanayiotides Theodoros , Chatterton Sophie , Wronski Miriam , Ng Karl , Kahnis Robert , Geeraerts Thomas , Reiner Peggy , Cordonnier Charlotte , Middeldorp Saskia , Levi Marcel , van Gorp Eric C. M. , van de Beek Diederik , Brodard Justine , Kremer Hovinga Johanna A. , Kruip Marieke J. H. A. , Tatlisumak Turgut , Ferro José M. , Coutinho Jonathan M. , Arnold Marcel , Poli Sven , Heldner Mirjam R. 
Published: June 2022

Objective

Cerebral venous thrombosis (CVT) caused by vaccine‐induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus‐based severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non‐heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality.

Methods

We used data from an international prospective registry of patients with CVT after the adenovirus‐based SARS‐CoV‐2 vaccination. We analyzed possible, probable, or definite VITT‐CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis.

Results

Ninety‐nine patients with VITT‐CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in‐line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16–1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06–0.58). Treatment with non‐heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24–2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74–6.54).

Conclusions

In patients with VITT‐CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT‐CVT. ANN NEUROL 2022;92:562–573