Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries

被引:3
作者
van de Munckhof, Anita [1 ]
Borhani-Haghighi, Afshin [2 ]
Aaron, Sanjith [3 ]
Krzywicka, Katarzyna [1 ]
van Kammen, Mayte Sanchez [1 ]
Cordonnier, Charlotte [4 ]
Kleinig, Timothy J. [5 ]
Field, Thalia S. [6 ]
Poli, Sven [7 ]
Lemmens, Robin [8 ]
Scutelnic, Adrian [9 ]
Lindgren, Erik [10 ,11 ]
Duan, Jiangang [12 ]
Arslan, Yildiz [13 ]
van Gorp, Eric C. M. [14 ]
Kremer Hovinga, Johanna A. [9 ]
Guenther, Albrecht [15 ]
Jood, Katarina [10 ,11 ]
Tatlisumak, Turgut [10 ,11 ]
Putaala, Jukka [16 ,17 ]
Heldner, Mirjam R. [9 ]
Arnold, Marcel [9 ]
de Sousa, Diana Aguiar [18 ]
Wasay, Mohammad [19 ]
Arauz, Antonio [20 ]
Conforto, Adriana Bastos [21 ]
Ferro, Jose M. [22 ]
Coutinho, Jonathan M. [1 ]
机构
[1] Univ Amsterdam, Locat Univ Amsterdam, Med Ctr, Amsterdam, Netherlands
[2] Shiraz Univ Med Sci, Shiraz, Iran
[3] Christian Med Coll & Hosp, Vellore, India
[4] Univ Lille, CHU Lille, Inserm, U1172 LilNCog Lille Neurosci & Cognit, Lille, France
[5] Royal Adelaide Hosp, Adelaide, SA, Australia
[6] Univ British Columbia, Vancouver, BC, Canada
[7] Eberhard Karls Univ Tubingen, Univ Hosp Tuebingen, Tubingen, Germany
[8] Univ Hosp Leuven, Leuven, Belgium
[9] Univ Bern, Bern Univ Hosp, Inselspital, Bern, Switzerland
[10] Sahlgrens Univ Hosp, Gothenburg, Sweden
[11] Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden
[12] Capital Med Univ, Xuanwu Hosp, Beijing, Peoples R China
[13] Medicana Izmir Int Hosp, Izmir, Turkiye
[14] Erasmus MC, Rotterdam, Netherlands
[15] Jena Univ Hosp, Jena, Germany
[16] Helsinki Univ Hosp, Helsinki, Finland
[17] Univ Helsinki, Helsinki, Finland
[18] Lisbon Cent Univ Hosp Ctr, Lisbon, Portugal
[19] Aga Khan Univ, Karachi, Pakistan
[20] Natl Inst Neurol & Neurosurg, Mexico City, Mexico
[21] Univ Sao Paulo, Hosp Clin, Sao Paulo, SP, Brazil
[22] Univ Lisbon, Fac Med, Inst Med Mol Joao Lobo Antunes, Lisbon, Portugal
关键词
CVST; VITT; COVID-19; vaccination; global health; thrombosis;
D O I
10.1177/17474930231182901
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
引用
收藏
页码:1112 / 1120
页数:9
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