Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase
Authors: van de Munckhof Anita , Lindgren Erik , Kleinig Timothy J. , Field Thalia S. , Cordonnier Charlotte , Krzywicka Katarzyna , Poli Sven , Sánchez van Kammen Mayte , Borhani-Haghighi Afshin , Lemmens Robin , Scutelnic Adrian , Ciccone Alfonso , Gattringer Thomas , Wittstock Matthias , Dizonno Vanessa , Devroye Annemie , Elkady Ahmed , Günther Albrecht , Cervera Alvaro , Mengel Annerose , Chew Beng Lim Alvin , Buck Brian , Zanferrari Carla , Garcia-Esperon Carlos , Jacobi Christian , Soriano Cristina , Michalski Dominik , Zamani Zohreh , Blacquiere Dylan , Johansson Elias , Cuadrado-Godia Elisa , Vuillier Fabrice , Bode Felix J. , Caparros François , Maier Frank , Tsivgoulis Georgios , Katzberg Hans D. , Duan Jiangang , Burrow Jim , Pelz Johann , Mbroh Joshua , Oen Joyce , Schouten Judith , Zimmermann Julian , Ng Karl , Garambois Katia , Petruzzellis Marco , Carvalho Dias Mariana , Ghiasian Masoud , Romoli Michele , Miranda Miguel , Wronski Miriam , Skjelland Mona , Almasi-Dooghaee Mostafa , Cuisenier Pauline , Murphy Seán , Timsit Serge , Coutts Shelagh B. , Schönenberger Silvia , Nagel Simon , Hiltunen Sini , Chatterton Sophie , Cox Thomas , Bartsch Thorsten , Shaygannejad Vahid , Mirzaasgari Zahra , Middeldorp Saskia , Levi Marcel M. , Kremer Hovinga Johanna A. , Jood Katarina , Tatlisumak Turgut , Putaala Jukka , Heldner Mirjam R. , Arnold Marcel , Aguiar de Sousa Diana , Ferro José M. , Coutinho Jonathan M. ,   for the Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group
Published: September 2022

Background:
Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization.

Methods:
We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0–2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization).

Results:
Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94–194). Two patients died during follow-up (3% [95% CI, 1%–11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%–94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed).

Conclusions:
In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.