Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19
Authors: Scutelnic Adrian , van de Munckhof Anita , Krzywicka Katarzyna , van Kammen Mayte Sánchez , Lindgren Erik , Cordonnier Charlotte , Kleinig Timothy J , Field Thalia S , Poli Sven , Lemmens Robin , Middeldorp Saskia , Aaron Sanjith , Borhani-Haghighi Afshin , Arauz Antonio , Kremer Hovinga Johanna A , Günther Albrecht , Putaala Jukka , Wasay Mohammad , Conforto Adriana Bastos , de Sousa Diana Aguiar , Jood Katarina , Tatlisumak Turgut , Ferro José M , Coutinho Jonathan M , Arnold Marcel , Heldner Mirjam R , Antonenko Kateryna , Mbroh Joshua , Brodard Justine , Hooshmandi Etrat , Dizonno Vanessa , Devroye Annemie , Ciccone Alfonso , Wittstock Matthias , Zimmermann Julian , Bode Felix J. , Skjelland Mona , Duan Jiangang , Hiltunen Sini , Zuurbier Susanna M. , Petruzzellis Marco , Sharma Aarti R. , Ghoreishi Abdoreza , Elkady Ahmed , Negro Alberto , Gutschalk Alexander , Schoenenberger Silvia , Nagel Simon , Buture Alina , Cervera Alvaro , Paiva Nunes Ana , Romina Montané Baños Ana , Tiede Andreas , Puthuppallil Anemon , Tuladhar Anil M. , Mengel Annerose , Medina Antonio , Hellström Vogel Åslög , Tawa Audrey , Aujayeb Avinash , Ramasamy Balakrishnan , Casolla Barbara , Lim Alvin Chew Beng , Ziaadini Bentalhoda , Varkey Maramattom Boby , Buck Brian , Zanferrari Carla , Garcia-Esperon Carlos , Vayne Caroline , Legault Catherine , Jacobi Christian , Pfrepper Christian , Pelz Johann , Wahl Christoph , Kern Rolf , Tracol Clement , Soriano Cristina , Guisado-Alonso Daniel , Bougon David , Bal Deepti , Sergio Zimatore Domenico , Michalski Dominik , Blacquiere Dylan , Johansson Elias , Cuadrado-Godia Elisa , Sadeghi-Hokmabadi Elyar , Carrera Emmanuel , De Maistre Emmanuel , Saxhaug Kristoffersen Espen , Bonneville Fabrice , Geeraerts Thomas , Vuillier Fabrice , Giammello Fabrizio , D’Onofrio Florindo , Grillo Francesco , Caparros François , Susen Sophie , Maier Frank , Tsivgoulis Georgios , Gulli Giosue , Frisullo Giovanni , Franchineau Guillaume , Cangür Hakan , Katzberg Hans , Mozhdehipanah Hossein , Sibon Igor , Baharoglu M. Irem , Masjuan Jaime , Brar Jaskiran , Payen Jean-Francois , Burrow Jim , Fernandes João , Octavio López Esparza Jorge , Oen Joyce , Schouten Judith , Ng Karl , Chatterton Sophie , Wronski Miriam , Althaus Katharina , Garambois Katia , Derex Laurent , Puy Laurent , Poorsaadat Leila , Valler Lenise , Januzi de Almeida Rocha Letícia , Humbertjean Lisa , Lebrato Hernandez Lucia , Murillo-Bonilla Luis , Kellermair Lukas , Morin Martin Mar , Sofia Cotelli Maria , Hernandez Perez Maria , Zedde Marialuisa , Carvalho Dias Mariana , Dubois Marie-Cecile , Carvalho Marta , Ghiasian Masoud , Umaiorubahan Meenakshisundaram , Kumar Karunakaran Ravi , Roozbeh Mehrdad , Romoli Michele , Miranda Miguel , Saadatnia Mohammad , Bandettini di Poggio Monica , Scholz Moritz J. , Kahnis Robert , Almasi-Dooghaee Mostafa , Hoseininejad Mir Nahid , Ichaporia Nasli R. , Kumar Paramasivan Naveen , Erat Sreedharan Sapna , Sylaja PN , Raposo Nicolas , Fadakar Nima , Kruyt Nyika , Detante Olivier , Cuisenier Pauline , Huet Olivier , Sharma Pankaj , Candelaresi Paolo , Scoppettuolo Pasquale , Reiner Peggy , Nemati Reza , Vieira Ricardo , Goh Rudy , Murphy Seán , Timsit Serge , Coutts Shelagh , Sharma Shyam S. , Bal Simerpreet , Kaul Subhash , Karapanayiotides Theodoros , Cox Thomas , Gattringer Thomas , Mathew Thomas , Bartsch Thorsten , Shaygannejad Vahid , Garcia-Talavera Veronica , Palma Vincenzo , Arslan Yıldız , Mirzaasgari Zahra , Yavari Zeinab , Zamani Zohreh , Bakchoul Tamam , Levi Marcel , van Gorp Eric C.M. 
Published: July 2023

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.