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Panos LD, Bargiotas P, Hadjigeorgiou G, Panos GD. Neurovascular Adverse Effects of Sars-Cov-2 Vaccination. Drug Des Devel Ther 2024; 18:1891-1905. [PMID: 38836116 PMCID: PMC11147783 DOI: 10.2147/dddt.s464394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
The global deployment of SARS-CoV-2 vaccines has been pivotal in curbing the COVID-19 pandemic, reducing morbidity and mortality associated with the virus. While most of these vaccines have demonstrated high efficacy and overall safety, emerging reports have highlighted potential neurovascular adverse effects, albeit uncommon, associated with these vaccinations. This review aims to assess and summarize the current knowledge on the neurovascular complications arising post-SARS-CoV-2 vaccination. We conducted an extensive literature review, focusing on clinical studies and case reports to identify reported neurovascular events, such as ischemic stroke, cerebral sinus venous thrombosis, intracerebral hemorrhage, pituitary apoplexy and primary CNS angiitis Despite the relative rarity of these events, their impact on affected individuals underscores the importance of ongoing surveillance, early detection, and management strategies. We aim to provide healthcare professionals with the latest evidence on neurovascular adverse effects, facilitating informed decision-making in the context of SARS-CoV-2 vaccination programs. Furthermore, we highlight areas requiring further research to understand the pathophysiology of these adverse events better and to develop targeted prevention and treatment strategies.
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Affiliation(s)
- Leonidas D Panos
- Department of Neurology, Bern University Hospital « Inselspital », Bern, Switzerland
- Department of Neurology, School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Panagiotis Bargiotas
- Department of Neurology, School of Medicine, University of Cyprus, Nicosia, Cyprus
| | | | - Georgios D Panos
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals (NUH), Nottingham, U.K
- Division of Ophthalmology and Visual Sciences, School of Medicine, University of Nottingham, Nottingham, U.K
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Weng SH, Yen YF, Cheng FS, Chou YC, Hu HY. Factors associated with willingness to receive coronavirus disease vaccination during the pandemic: A nationwide survey in Taiwan. J Formos Med Assoc 2024:S0929-6646(24)00242-0. [PMID: 38740535 DOI: 10.1016/j.jfma.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND/PURPOSE Vaccination is the most important preventive measure to protect people from coronavirus disease 2019 (COVID-19). Governments worldwide have prioritized their vaccination policy against COVID-19. However, there is a lack of relevant research on Taiwanese attitudes and considerations toward COVID-19 vaccination. This study aimed to investigate the cognition, preventive behaviors, and attitudes toward COVID-19 vaccines that influence people's willingness to get vaccinated in Taiwan. METHODS From October 1 to 31, 2021, a computer-assisted telephone interview system was used to randomly select Taiwanese people to investigate their COVID-19 preventive behaviors, knowledge, and willingness to be vaccinated. RESULTS We included 2000 participants of whom 96.45% showed vaccination willingness. The overall mean age and knowledge scores were 48.6 years and 5.78, respectively. All of the participants chose to wear masks, and 80% chose to be vaccinated to prevent COVID-19. Compared with the non-willing vaccination participants, those with younger ages, higher incomes, and higher knowledge scores regarding masks and vaccination were more likely to be vaccinated. Furthermore, apprehensions about vaccine side effects and negative news about COVID-19 vaccines were the major reasons for vaccination hesitancy. CONCLUSION To improve people's willingness to get vaccinated, the government should strive to deliver correct knowledge and refute inappropriate negative information about COVID-19 vaccination. Moreover, recommendation by physicians was an important factor for older individuals to decide on receiving the COVID-19 vaccine, and policies could be implemented from this aspect.
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Affiliation(s)
- Shih-Han Weng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; University of Taipei, Taipei, Taiwan.
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; University of Taipei, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; University of Taipei, Taipei, Taiwan.
| | - Yi-Chang Chou
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; University of Taipei, Taipei, Taiwan.
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; University of Taipei, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Wittstock M, Cantré D, Won SY, Jürs AV, Wesche J, Greger N, Greinacher A, Thiele T. An anti-PF4 antibody-related disorder with cerebral venous sinus thrombosis and thrombocytopenia initially presenting as intracranial hemorrhage. J Neurol 2024:10.1007/s00415-024-12373-6. [PMID: 38597942 DOI: 10.1007/s00415-024-12373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Matthias Wittstock
- Department of Neurology, University Medical Center Rostock, Schillingallee 36, 18057, Rostock, Germany.
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany
| | - Alexandra V Jürs
- Department of Neurology, University Medical Center Rostock, Schillingallee 36, 18057, Rostock, Germany
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Jan Wesche
- Institute of Transfusion Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Nico Greger
- Institute of Transfusion Medicine, University Medical Center Rostock, Rostock, Germany
| | - Andreas Greinacher
- Institute of Transfusion Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Thomas Thiele
- Institute of Transfusion Medicine, University Medical Center Greifswald, Greifswald, Germany
- Institute of Transfusion Medicine, University Medical Center Rostock, Rostock, Germany
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Scutelnic A, van de Munckhof A, Miraclin AT, Aaron S, Hameed S, Wasay M, Grosu O, Krzywicka K, Sánchez van Kammen M, Lindgren E, Moreira T, Acampora R, Negro A, Karapanayiotides T, Yaghi S, Revert A, Cuadrado Godia E, Garcia-Madrona S, La Spina P, Grillo F, Giammello F, Nguyen TN, Abdalkader M, Buture A, Sofia Cotelli M, Raposo N, Tsivgoulis G, Candelaresi P, Ciacciarelli A, Mbroh J, Batenkova T, Scoppettuolo P, Zedde M, Pascarella R, Antonenko K, Kristoffersen ES, Kremer Hovinga JA, Jood K, Aguiar de Sousa D, Poli S, Tatlisumak T, Putaala J, Coutinho JM, Ferro JM, Arnold M, Heldner MR. Characteristics and outcomes of cerebral venous thrombosis associated with COVID-19. Eur Stroke J 2024:23969873241241885. [PMID: 38572798 DOI: 10.1177/23969873241241885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Previous reports and meta-analyses derived from small case series reported a mortality rate of up to 40% in patients with coronavirus disease 2019 associated cerebral venous thrombosis (COVID-CVT). We assessed the clinical characteristics and outcomes in an international cohort of patients with COVID-CVT. PATIENTS AND METHODS This was a registry study of consecutive COVID-CVT patients diagnosed between March 2020 and March 2023. Data collected by the International Cerebral Venous Thrombosis Consortium from patients with CVT diagnosed between 2017 and 2018 served as a comparison. Outcome analyses were adjusted for age and sex. RESULTS We included 70 patients with COVID-CVT from 23 hospitals in 15 countries and 206 controls from 14 hospitals in 13 countries. The proportion of women was smaller in the COVID-CVT group (50% vs 68%, p < 0.01). A higher proportion of COVID-CVT patients presented with altered mental state (44% vs 25%, p < 0.01), the median thrombus load was higher in COVID-CVT patients (3 [IQR 2-4] vs 2 [1-3], p < 0.01) and the length of hospital stay was longer compared to controls (11 days [IQR 7-20] vs 8 [4-15], p = 0.02). In-hospital mortality did not differ (5/67 [7%, 95% CI 3-16] vs 7/206 [3%, 2-7], aOR 2.6 [95% CI 0.7-9]), nor did the frequency of functional independence after 6 months (modified Rankin Scale 0-2; 45/58 [78%, 95% CI 65-86] vs 161/185 [87%, 81-91], aOR 0.5 [95% CI 0.2-1.02]). CONCLUSION In contrast to previous studies, the in-hospital mortality rate and functional outcomes during follow-up did not differ between COVID-CVT patients and the pre-COVID-19 controls.
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Angel T Miraclin
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | | | - Oxana Grosu
- Institute of Neurology and Neurosurgery "Diomid Gherman," Chisinau, Republic of Moldova
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Tiago Moreira
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Roberto Acampora
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - Alberto Negro
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Aristotle University of Thessaloniki, School of Medicine, AHEPA University Hospital, Greece
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI, USA
| | - Anna Revert
- Hospital del Mar, Faculty of Medicine and Life Sciences, Pompeu Fabra University Barcelona, Spain
| | - Elisa Cuadrado Godia
- Hospital del Mar, Faculty of Medicine and Life Sciences, Pompeu Fabra University Barcelona, Spain
| | | | - Paolino La Spina
- Translational Molecular Medicine and Surgery 36th Cycle, Department of BIOMORF, Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Francesco Grillo
- Translational Molecular Medicine and Surgery 36th Cycle, Department of BIOMORF, Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery 36th Cycle, Department of BIOMORF, Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Thanh N Nguyen
- Neurology, Boston Medical Center, MA, USA
- Radiology, Boston Medical Center, MA, USA
| | | | - Alina Buture
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Nicolas Raposo
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, "Attikon University Hospital", Athens, Greece
| | | | - Antonio Ciacciarelli
- Neurology Division, Santa Maria Goretti Hospital, Latina, Italy
- Department of Translation and Precision Medicine, Sapienza University of Rome, Italy
| | - Joshua Mbroh
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Pasquale Scoppettuolo
- Neurology Department, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Diana Aguiar de Sousa
- Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - José M Ferro
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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5
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Pelz JO, Kenda M, Alonso A, Etminan N, Wittstock M, Niesen WD, Lambeck J, Güresir E, Wach J, Lampmannn T, Dziewas R, Wiedmann M, Schneider H, Bayas A, Christ M, Mengel A, Poli S, Brämer D, Lindner D, Pfrepper C, Roth C, Salih F, Günther A, Michalski D. Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study. Neurocrit Care 2024; 40:621-632. [PMID: 37498459 PMCID: PMC10959787 DOI: 10.1007/s12028-023-01782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome. METHODS This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS. RESULTS Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043). CONCLUSIONS Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients.
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Affiliation(s)
- Johann Otto Pelz
- Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Martin Kenda
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany
| | - Angelika Alonso
- Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Wolf-Dirk Niesen
- Department of Neurology and Clinical Neurophysiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Johann Lambeck
- Department of Neurology and Clinical Neurophysiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Tim Lampmannn
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck, Osnabrueck, Germany
| | - Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Antonios Bayas
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Monika Christ
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Dirk Brämer
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Dirk Lindner
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Christian Pfrepper
- Division of Haemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany
| | - Christian Roth
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - Farid Salih
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Weller J, Krzywicka K, van de Munckhof A, Dorn F, Althaus K, Bode FJ, Bandettini di Poggio M, Buck B, Kleinig T, Cordonnier C, Dizonno V, Duan J, Elkady A, Chew BLA, Garcia-Esperon C, Field TS, Legault C, Morin Martin M, Michalski D, Pelz J, Schoenenberger S, Nagel S, Petruzzellis M, Raposo N, Skjelland M, Zimatore DS, Aaron S, Sanchez van Kammen M, Aguiar de Sousa D, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Arauz A, Conforto AB, Putaala J, Tatlisumak T, Arnold M, Coutinho JM, Günther A, Zimmermann J, Ferro JM. Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur Stroke J 2024; 9:105-113. [PMID: 37771138 PMCID: PMC10916823 DOI: 10.1177/23969873231202363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT. PATIENTS AND METHODS We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria. RESULTS EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58). DISCUSSION AND CONCLUSION We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
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Affiliation(s)
- Johannes Weller
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, AB, Canada
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Lille, France
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | | | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Legault
- Division of Neurology, McGill University Health Centre, Montreal, QC, Canada
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | | | - Johann Pelz
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Marco Petruzzellis
- Neuroradiology Unit, Azienda Ospedaliera Consorziale Policlinico di Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France and Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mayte Sanchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Stroke Centre, Lisbon Central University Hospital, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany and Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - José M Ferro
- Centro de Estudas Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. Stroke 2024; 55:e77-e90. [PMID: 38284265 DOI: 10.1161/str.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
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Wittayer M, Sandikci V, Ebert A, Koehler C, Szabo K, Hoyer C. [Potential Impact of Public Communication on Emergency Presentations due to Headache during the Covid-19 Pandemic]. DAS GESUNDHEITSWESEN 2024; 86:232-236. [PMID: 38065548 DOI: 10.1055/a-2146-6286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Headache is a frequent presenting symptom in the emergency department. While most cases are of benign aetiology, it is crucially important to identify potentially dangerous underlying disorders. We hypothesized an increase in headache-related emergency presentations after venous thrombosis of cerebral sinuses had been identified as a rare side effect of vaccination with adenovirus vector-based Coronavirus-disease 2019 (COVID-19) vaccines and that information had been publicly communicated by the Paul Ehrlich Institute. Data from patients with the diagnosis of primary headache disorders or unspecified headache presenting to the Interdisciplinary Emergency Department of the University Medicine Mannheim were retrospectively analysed. Based on vaccination dashboard data published by the Federal Ministry of Health, calendar weeks 14-30 and 47-48, on the one hand, and 1-13 and 31-46, on the othe, were categorized into a variable "vaccination epoch" (14-30, 47-48: high vaccination activity if≥3 million weekly vaccinations in Germany; 1-13, 31-46: low vaccination activity if<3 million weekly vaccinations). The number of patients with headache was the dependent variable. A Poisson regression was performed to analyze whether the frequency of events, i. e., patient presentations, was a function of year (2019, 2021), epoch (high, low) and an interaction of year and epoch - the latter reflecting an impact of vaccination activity during the pandemic and expressed as incidence rate ratio. Compared to 2019, there was a more than 70% increase in presentations due to headache during periods of high vaccination activity in 2021 (p<0.001; 95% confidence interval 1.272-2.316), in 25% of presentations in 2021, patients considered their headache as vaccination-associated. Public communication and resulting nocebo effects may, among other factors, have contributed to our observation of increased numbers of emergency headache presentations, illustrating the impact of public distribution of medical information on practical aspects of emergency care during crises.
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Affiliation(s)
- Matthias Wittayer
- Neurologie, Universitätsklinikum Mannheim Klinik für Neurologie, Mannheim, Germany
| | - Vesile Sandikci
- Neurologie, Universitätsklinikum Mannheim Klinik für Neurologie, Mannheim, Germany
| | - Anne Ebert
- Neurologie, Universitätsklinikum Mannheim Klinik für Neurologie, Mannheim, Germany
| | - Clemens Koehler
- Neurologie, Universitätsklinikum Mannheim Klinik für Neurologie, Mannheim, Germany
| | - Kristina Szabo
- Neurologie, Universitätsklinikum Mannheim Klinik für Neurologie, Mannheim, Germany
| | - Carolin Hoyer
- Neurologie, Universitätsklinikum Mannheim Klinik für Neurologie, Mannheim, Germany
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Maan R, Lauw MN, China L, Patch D, Baiges A, Garcia-Pagan JC, Hernández-Gea V, Hilleret MN, Tjwa ET, Kounis I, Bureau C, Giguet B, Heurgué A, Ollivier-Hourmand I, Causse X, Nery F, Eshraghian A, Plessier A, Darwish Murad S. Extensive splanchnic vein thrombosis after SARS-CoV-2 vaccination: A Vascular Liver Disease Group (VALDIG) initiative. Hepatology 2024:01515467-990000000-00747. [PMID: 38358465 DOI: 10.1097/hep.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIMS Since the introduction of SARS-CoV-2 vaccines, several cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) have been described, especially cerebral vein thrombosis. We aimed to retrospectively collect all new cases of acute onset first or recurrent splanchnic vein thrombosis (SVT) following a recent SARS-CoV-2 vaccination within the Vascular Liver Disease Group network. APPROACH AND RESULTS New cases of SVT were identified from April 2021 to April 2022; follow-up was completed on December 31, 2022. Criteria to define VITT were derived from previous studies. Data from a pre-COVID cohort of patients with SVT (N=436) were used for comparison of clinical presentation, etiology, and outcome. Twenty-nine patients were identified with SVT occurring with a median of 11 days (range 2-76) after the first (48%), second (41%), or third (10%) vaccination (ChAdOx1 nCov-19 (n=12) or BNT162b2 (n=14), other (n=3) Only 2 patients(7%) fulfilled criteria for definite VITT. Twenty (69%) had SVT at multiple sites, including 4 (14%) with concomitant extra-abdominal thrombosis. Only 28% had an underlying prothrombotic condition, compared to 52% in the pre-COVID SVT cohort ( p =0.01). Five patients (17%) underwent bowel resection for mesenteric ischemia, compared with 3% in pre-COVID SVT ( p <0.001). Two patients died shortly after diagnosis (7%). CONCLUSIONS Although definite VITT was rare, in 72% of cases, no other cause for SVT could be identified following SARS-CoV-2 vaccination. These cases were different from patients with nonvaccine-related SVT, with lower incidence of prothrombotic conditions, higher rates of bowel ischemia, and poorer outcome. Although SVT after SARS-CoV-2 vaccination is rare in absolute terms, these data remain relevant considering ongoing revaccination programs.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mandy N Lauw
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Loise China
- Institute of Liver and Digestive Health, University College London, United Kingdom
| | - David Patch
- Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anna Baiges
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Juan Carlos Garcia-Pagan
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Virginia Hernández-Gea
- v Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona. CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas)
| | - Marie-Noelle Hilleret
- Service d'Hépato-Gastroentérologie, CHU Grenoble Alpes, 38043 Grenoble Cedex, France
| | - Eric T Tjwa
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilias Kounis
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire ; Inserm, Université Paris-Saclay, Université Paris-Saclay, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, France
| | - Christophe Bureau
- University Hospital of Toulouse and Toulouse III Paul Sabatier University, Toulouse, France
| | - Baptiste Giguet
- Liver Disease Department, CHU Rennes, Univ Rennes, Rennes, France
| | | | | | - Xavier Causse
- Department of Hepatology and Gastroenterology, Orleans, France
| | - Filipe Nery
- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- EpiUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Ahad Eshraghian
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran
| | - Aurélie Plessier
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Centre de recherche sur l'inflammation, Inserm, Paris, France
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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10
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Ken-Dror G, Sharma P. ABO blood group associated with cerebral venous thrombosis after Oxford-AstraZeneca COVID-19 vaccination: a case-control study. J R Soc Med 2024; 117:69-76. [PMID: 38086410 PMCID: PMC10949869 DOI: 10.1177/01410768231214341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/29/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES To determine whether blood group influences development of cerebral venous thrombosis (CVT) after administration of the coronavirus disease 2019 (COVID-19) AstraZeneca ChAdOx1-S vaccine. DESIGN A case-control study. Univariate and multivariate logistic regression was used to determine the association between blood type and COVID-19 vaccination status. SETTING Vaccinated and unvaccinated patients recruited from the international Bio-Repository to Establish the Aetiology of Sinovenous Thrombosis study and the Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group. PARTICIPANTS All patients were of European descent and age and sex matched. Cases (n = 82) were patients ≥18 years old who suffered a CVT within 28 days of a first dose of ChAdOx1-S vaccine. Controls (n = 441) were unvaccinated CVT patients ≥18 years old. All patients were of European descent. MAIN OUTCOME MEASURES Frequency of blood type and ABO allele distribution by vaccination status. RESULTS Blood group O was found to be more prevalent among CVT patients with vaccine-induced thrombotic thrombocytopenia (VITT-CVT) after ChAdOx1-S vaccination compared with unvaccinated CVT cases (43% vs. 17%, respectively, p < 0.001). Blood group A was less prevalent, though still high, in the vaccinated group compared with the unvaccinated group (47% vs. 71%, respectively, p < 0.001). No significant differences were observed in the VITT-CVT non-ChAdOx1-S vaccine group and unvaccinated pre-COVID-19 CVT group for blood group. CONCLUSIONS Blood group O is more prevalent among patients with VITT-CVT after ChAdOx1-S vaccination compared with unvaccinated cases, independent of well-established CVT risk factors. A larger dataset may be able to determine whether those of blood groups B and/or AB may be safely vaccinated with the low cost, readily available and easily transported ChAdOx1-S rather than adopting a complete ban.
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Affiliation(s)
- Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London TW20 0EX, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London TW20 0EX, UK
- Department of Clinical Neurology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
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11
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Borhani-Haghighi A, Hooshmandi E. Cerebral venous thrombosis: a practical review. Postgrad Med J 2024; 100:68-83. [PMID: 37978050 DOI: 10.1093/postmj/qgad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.
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Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
- Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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12
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Weissert R. Nervous system-related tropism of SARS-CoV-2 and autoimmunity in COVID-19 infection. Eur J Immunol 2024; 54:e2250230. [PMID: 37733584 DOI: 10.1002/eji.202250230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/05/2023] [Accepted: 09/20/2023] [Indexed: 09/23/2023]
Abstract
The effects of SARS-CoV-2 in COVID-19 on the nervous system are incompletely understood. SARS-CoV-2 can infect endothelial cells, neurons, astrocytes, and oligodendrocytes with consequences for the host. There are indications that infection of these CNS-resident cells may result in long-term effects, including emergence of neurodegenerative diseases. Indirect effects of infection with SARS-CoV-2 relate to the induction of autoimmune disease involving molecular mimicry or/and bystander activation of T- and B cells and emergence of autoantibodies against various self-antigens. Data obtained in preclinical models of coronavirus-induced disease gives important clues for the understanding of nervous system-related assault of SARS-CoV-2. The pathophysiology of long-COVID syndrome and post-COVID syndrome in which autoimmunity and immune dysregulation might be the driving forces are still incompletely understood. A better understanding of nervous-system-related immunity in COVID-19 might support the development of therapeutic approaches. In this review, the current understanding of SARS-CoV-2 tropism for the nervous system, the associated immune responses, and diseases are summarized. The data indicates that there is viral tropism of SARS-CoV-2 in the nervous system resulting in various disease conditions. Prevention of SARS-CoV-2 infection by means of vaccination is currently the best strategy for the prevention of subsequent tissue damage involving the nervous system.
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Affiliation(s)
- Robert Weissert
- Department of Neurology, University of Regensburg Hospital, Regensburg, Germany
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13
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Ranjan R, Ken-Dror G, Sharma P. Pathophysiology, diagnosis and management of cerebral venous thrombosis: A comprehensive review. Medicine (Baltimore) 2023; 102:e36366. [PMID: 38050259 PMCID: PMC10695550 DOI: 10.1097/md.0000000000036366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
Cerebral venous thrombosis is a rare cause of stroke in young mostly female adults which is frequently overlooked due to its variable clinical and radiological presentation. This review summarizes current knowledge on it risk factors, management and outcome in adults and highlights areas for future research. Females are 3 times more commonly affected and are significantly younger than males. The presenting symptoms can range from headache to loss of consciousness. However, the often-nebulous nature of symptoms can make the diagnosis challenging. Magnetic resonance imaging with venography is often the diagnostic imaging of choice. While unfractionated or low molecular-weight heparin is the mainstay of treatment, endovascular intervention with thrombolysis or thrombectomy and decompressive craniectomy may be required depending on clinical status. Nevertheless, approximately 80% of patients have a good recovery but mortality rates of -5% to 10% are not uncommon. Diagnosing cerebral venous thrombosis can be challenging but with vigilance and expert care patients have the best chance of a good clinical outcome.
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Affiliation(s)
- Redoy Ranjan
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
| | - Gie Ken-Dror
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
- Department of Clinical Neurology, Imperial College London Healthcare NHS Trust, London, United Kingdom
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14
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Scutelnic A, van de Munckhof A, Krzywicka K, van Kammen MS, Lindgren E, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Middeldorp S, Aaron S, Borhani-Haghighi A, Arauz A, Kremer Hovinga JA, Günther A, Putaala J, Wasay M, Conforto AB, de Sousa DA, Jood K, Tatlisumak T, Ferro JM, Coutinho JM, Arnold M, Heldner MR. Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19. Eur Stroke J 2023; 8:1001-1010. [PMID: 37434312 PMCID: PMC10345391 DOI: 10.1177/23969873231185213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
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.
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Thalia S Field
- Devision of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sanjith Aaron
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suárez, Mexico City
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | - Diana Aguiar de Sousa
- Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Theodorou DJ, Theodorou SJ, Rizos D. Major cardiovascular events after COVID-19, event rates post-vaccination, antiviral or anti-inflammatory therapy, and temporal trends: Rationale and methodology of the CORONA-VTE-Network study. Thromb Res 2023; 232:146-147. [PMID: 37734969 DOI: 10.1016/j.thromres.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Affiliation(s)
| | | | - Dimitrios Rizos
- Department of Internal Medicine, Intensive Care Unit, General Hospital of Ioannina, Greece
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16
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Ivanov DG, Ivetic N, Du Y, Nguyen SN, Le SH, Favre D, Nazy I, Kaltashov IA. Reverse Engineering of a Pathogenic Antibody Reveals the Molecular Mechanism of Vaccine-Induced Immune Thrombotic Thrombocytopenia. J Am Chem Soc 2023; 145:25203-25213. [PMID: 37949820 DOI: 10.1021/jacs.3c07846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The massive COVID-19 vaccine roll-out campaign illuminated a range of rare side effects, the most dangerous of which─vaccine-induced immune thrombotic thrombocytopenia (VITT)─is caused by adenoviral (Ad)-vectored vaccines. VITT occurrence had been linked to the production of pathogenic antibodies that recognize an endogenous chemokine, platelet factor 4 (PF4). Mass spectrometry (MS)-based evaluation of the ensemble of anti-PF4 antibodies obtained from a VITT patient's blood indicates that the major component is a monoclonal antibody. Structural characterization of this antibody reveals several unusual characteristics, such as the presence of an N-glycan in the Fab segment and high density of acidic amino acid residues in the complementarity-determining regions. A recombinant version of this antibody (RVT1) was generated by transient expression in mammalian cells based on the newly determined sequence. It captures the key properties of VITT antibodies such as their ability to activate platelets in a PF4 concentration-dependent fashion. Homology modeling of the Fab segment reveals a well-defined polyanionic paratope, and the docking studies indicate that the polycationic segment of PF4 readily accommodates two Fab segments, cross-linking the antibodies to yield polymerized immune complexes. Their existence was verified with native MS by detecting assemblies as large as (RVT1)3(PF4)2, pointing out at FcγRIIa-mediated platelet activation as the molecular mechanism underlying VITT clinical manifestations. In addition to the high PF4 affinity, RVT1 readily binds other polycationic targets, indicating a polyreactive nature of this antibody. This surprising promiscuity not only sheds light on VITT etiology but also opens up a range of opportunities to manage this pathology.
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Affiliation(s)
- Daniil G Ivanov
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Nikola Ivetic
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Yi Du
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Son N Nguyen
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - S Hung Le
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Daniel Favre
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Igor A Kaltashov
- Department of Chemistry, University of Massachusetts-Amherst, Amherst, Massachusetts 01003, United States
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Field TS, Dizonno V, Almekhlafi MA, Bala F, Alhabli I, Wong H, Norena M, Villaluna MK, King-Azote P, Ratnaweera N, Mancini S, Van Gaal SC, Wilson LK, Graham BR, Sposato LA, Blacquiere D, Dewar BM, Boulos MI, Buck BH, Odier C, Perera KS, Pikula A, Tkach A, Medvedev G, Canfield C, Mortenson WB, Nadeau JO, Alshimemeri S, Benavente OR, Demchuk AM, Dowlatshahi D, Lanthier S, Lee AYY, Mandzia J, Suryanarayan D, Weitz JI, Hill MD. Study of Rivaroxaban for Cerebral Venous Thrombosis: A Randomized Controlled Feasibility Trial Comparing Anticoagulation With Rivaroxaban to Standard-of-Care in Symptomatic Cerebral Venous Thrombosis. Stroke 2023; 54:2724-2736. [PMID: 37675613 PMCID: PMC10615774 DOI: 10.1161/strokeaha.123.044113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Emerging data suggest that direct oral anticoagulants may be a suitable choice for anticoagulation for cerebral venous thrombosis (CVT). However, conducting high-quality trials in CVT is challenging as it is a rare disease with low rates of adverse outcomes such as major bleeding and functional dependence. To facilitate the design of future CVT trials, SECRET (Study of Rivaroxaban for Cerebral Venous Thrombosis) assessed (1) the feasibility of recruitment, (2) the safety of rivaroxaban compared with standard-of-care anticoagulation, and (3) patient-centered functional outcomes. METHODS This was a phase II, prospective, open-label blinded-end point 1:1 randomized trial conducted at 12 Canadian centers. Participants were aged ≥18 years, within 14 days of a new diagnosis of symptomatic CVT, and suitable for oral anticoagulation; they were randomized to receive rivaroxaban 20 mg daily, or standard-of-care anticoagulation (warfarin, target international normalized ratio, 2.0-3.0, or low-molecular-weight heparin) for 180 days, with optional extension up to 365 days. Primary outcomes were annual rate of recruitment (feasibility); and a composite of symptomatic intracranial hemorrhage, major extracranial hemorrhage, or mortality at 180 days (safety). Secondary outcomes included recurrent venous thromboembolism, recanalization, clinically relevant nonmajor bleeding, and functional and patient-reported outcomes (modified Rankin Scale, quality of life, headache, mood, fatigue, and cognition) at days 180 and 365. RESULTS Fifty-five participants were randomized. The rate of recruitment was 21.3 participants/year; 57% of eligible candidates consented. Median age was 48.0 years (interquartile range, 38.5-73.2); 66% were female. There was 1 primary event (symptomatic intracranial hemorrhage), 2 clinically relevant nonmajor bleeding events, and 1 recurrent CVT by day 180, all in the rivaroxaban group. All participants in both arms had at least partial recanalization by day 180. At enrollment, both groups on average reported reduced quality of life, low mood, fatigue, and headache with impaired cognitive performance. All metrics improved markedly by day 180. CONCLUSIONS Recruitment targets were reached, but many eligible participants declined randomization. There were numerically more bleeding events in patients taking rivaroxaban compared with control, but rates of bleeding and recurrent venous thromboembolism were low overall and in keeping with previous studies. Participants had symptoms affecting their well-being at enrollment but improved over time. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03178864.
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Affiliation(s)
- Thalia S Field
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada (M.A.A., F.B., I.A., A.M.D., M.D.H.)
| | - Fouzi Bala
- Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada (M.A.A., F.B., I.A., A.M.D., M.D.H.)
- Department of Radiology, Tours University Hospital, France (F.B.)
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada (M.A.A., F.B., I.A., A.M.D., M.D.H.)
| | - Hubert Wong
- School of Population and Public Health, and Centre for Health Outcomes and Evaluative Sciences (H.W., M.N.), University of British Columbia, Canada
| | - Monica Norena
- School of Population and Public Health, and Centre for Health Outcomes and Evaluative Sciences (H.W., M.N.), University of British Columbia, Canada
| | - Maria Karina Villaluna
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Princess King-Azote
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Namali Ratnaweera
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Steven Mancini
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Stephen C Van Gaal
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Laura K Wilson
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Brett R Graham
- Division of Neurology, University of Saskatchewan College of Medicine, Saskatoon, Canada (B.R.G.)
| | - Luciano A Sposato
- Department of Clinical Neurosciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada (L.A.S., J.M.)
| | - Dylan Blacquiere
- Ottawa Stroke Program, Ottawa Hospital Research institute, University of Ottawa, Canada (D.B., B.M.D., D.D.)
| | - Brian M Dewar
- Ottawa Stroke Program, Ottawa Hospital Research institute, University of Ottawa, Canada (D.B., B.M.D., D.D.)
| | - Mark I Boulos
- Sunnybrook Research Institute, Division of Neurology (M.I.B.), University Health Network, University of Toronto, Canada
| | - Brian H Buck
- Division of Neurology, University of Alberta, Edmonton, Canada (B.H.B.)
| | - Celine Odier
- Département de Neurosciences, Centre Hospitalier d'Université de Montréal, Université de Montréal, Canada (C.O.)
| | - Kanjana S Perera
- Population Health Research Institute and Division of Neurology, McMaster University, Hamilton, Canada (K.S.P.)
| | - Aleksandra Pikula
- Krembil Brain Institute (A.P.), University Health Network, University of Toronto, Canada
| | - Aleksander Tkach
- Kelowna General Hospital, Interior Health Authority, Canada (A.T.)
| | - George Medvedev
- Royal Columbian Hospital, Fraser Health Authority, New Westminster, Canada (G.M.)
| | - Carolyn Canfield
- Department of Family Practice, Innovation Support Unit (C.C.), University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy (W.B.M.), University of British Columbia, Vancouver, Canada
| | | | | | - Oscar R Benavente
- Vancouver Stroke Program, Division of Neurology (T.S.F., V.D., M.K.V., P.K-A., N.R., S.M., S.C.V.G., L.K.W., O.R.B.), University of British Columbia, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada (M.A.A., F.B., I.A., A.M.D., M.D.H.)
| | - Dar Dowlatshahi
- Ottawa Stroke Program, Ottawa Hospital Research institute, University of Ottawa, Canada (D.B., B.M.D., D.D.)
| | - Sylvain Lanthier
- Hôpital de Sacre-Coeur de Montréal, Département de Neurosciences, Université de Montréal, Canada (S.L.)
| | - Agnes Y Y Lee
- Division of Hematology (A.Y.Y.L.), University of British Columbia, Vancouver, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurosciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada (L.A.S., J.M.)
| | - Deepa Suryanarayan
- Division of Hematology, Cumming School of Medicine (D.S.), University of British Columbia, Vancouver, Canada
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada (J.I.W.)
| | - Michael D Hill
- Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada (M.A.A., F.B., I.A., A.M.D., M.D.H.)
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18
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Nath A. Neurologic Complications With Vaccines: What We Know, What We Don't, and What We Should Do. Neurology 2023; 101:621-626. [PMID: 37185124 PMCID: PMC10573146 DOI: 10.1212/wnl.0000000000207337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
Over the previous half century, vaccines have shaped human life by eradicating or nearly eradicating infections that were once a major cause of morbidity and mortality. The number of infections for which vaccines are now available has steadily increased. The types of vaccines have evolved over the years from crude extracts to more refined messenger RNA or protein-based vaccines. With these well-defined manufacturing processes, the safety profile has also improved. Despite such measures, vaccines are not without side effects, including those that affect the nervous system. Numerous case reports and case series point to these possibilities. These issues have gathered much attention during the current mass vaccination against severe acute respiratory syndrome coronavirus 2 and have resulted in some members of the public raising concerns about vaccine safety. The vaccine manufacturers have legal protection against vaccine side effects; however, there are active and passive surveillance programs put in place by the Center for Disease Control and Prevention, the US Food and Drug Administration, the World Health Organization, and the European Union. Action is needed that brings together manufactures, healthcare agencies, clinical and bench scientists, and legislatures on a global platform to investigate vaccine-related neurologic adverse events and develop ways to prevent and treat them.
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Affiliation(s)
- Avindra Nath
- From the National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
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19
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Zhou Y, Jiang H, Wei H, Xiao X, Liu L, Ji X, Zhou C. Cerebral venous thrombosis in patients with autoimmune disease, hematonosis or coronavirus disease 2019: Many familiar faces and some strangers. CNS Neurosci Ther 2023; 29:2760-2774. [PMID: 37365966 PMCID: PMC10493677 DOI: 10.1111/cns.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis, a rare stroke, is characterized by neurological dysfunction caused by bleeding and/or infarction resulting from venous sinus thrombosis, the so-called venous stroke. Current guidelines recommend anticoagulants as first-line therapy in the treatment of venous stroke. With complicated causes of cerebral venous thrombosis, treatment is difficult, especially when combined with autoimmune diseases, blood diseases, and even COVID-19. AIMS This review summarizes the pathophysiological mechanisms, epidemiology, diagnosis, treatment, and clinical prognosis of cerebral venous thrombosis combined with autoimmune diseases, blood diseases, or infectious diseases such as COVID-19. CONCLUSION A systematic understanding of particular risk factors that should not be neglected when unconventional cerebral venous thrombosis occurs and for a scientific understanding of pathophysiological mechanisms, clinical diagnosis, and treatment, thus contributing to knowledge on special types of venous stroke.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Xuechun Xiao
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Lu Liu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
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20
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van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, van Kammen MS, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Scutelnic A, Lindgren E, Duan J, Arslan Y, van Gorp ECM, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, de Sousa DA, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. Int J Stroke 2023; 18:1112-1120. [PMID: 37277922 PMCID: PMC10614174 DOI: 10.1177/17474930231182901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Anita van de Munckhof
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Katarzyna Krzywicka
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, Lille, France
| | | | | | - Sven Poli
- University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Adrian Scutelnic
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erik Lindgren
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jiangang Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yıldız Arslan
- Medicana İzmir International Hospital, Izmir, Turkey
| | | | | | | | - Katarina Jood
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirjam R Heldner
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jonathan M Coutinho
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
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21
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Huynh A, Arnold DM, Ivetic N, Clare R, Hadzi-Tosev M, Liu Y, Smith JW, Bissola AL, Daka M, Kelton JG, Nazy I. Antibodies against platelet factor 4 and the risk of cerebral venous sinus thrombosis in patients with vaccine-induced immune thrombotic thrombocytopenia. J Thromb Haemost 2023; 21:2833-2843. [PMID: 37394121 DOI: 10.1016/j.jtha.2023.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication of adenoviral vector-based vaccines against SARS-CoV-2. This syndrome is caused by antibodies against platelet factor 4 (PF4; CXCL4) that lead to platelet activation and is characterized by thrombocytopenia and thrombosis in unusual locations, including cerebral venous sinus thrombosis (CVST). VITT can be classified based on anti-PF4 antibodies properties in vitro: those that require PF4 to activate platelets (PF4-dependent) and those that can activate platelets without additional PF4 (PF4-independent) in the serotonin release assay. OBJECTIVES We aim to characterize the relationship of VITT platelet-activating profiles with CVST. METHODS We conducted a retrospective cohort study involving patients with confirmed VITT who were tested between March and June 2021. Data were collected with an anonymized form and cases were identified as VITT with high clinical suspicion according to platelet activation assays. Anti-PF4 antibody binding regions on PF4 were further characterized with alanine scanning mutagenesis. RESULTS Of the patients with confirmed VITT (n = 39), 17 (43.6%) had PF4-dependent antibodies and 22 (56.4%) had PF4-independent antibodies. CVST occurred almost exclusively in PF4-independent patients (11 of 22 vs 1 of 17; P < .05). Additionally, PF4-independent antibodies bound to 2 distinct epitopes on PF4, the heparin-binding region and a site typical for heparin-induced thrombocytopenia antibodies, whereas PF4-dependent antibodies bound to only the heparin-binding region. CONCLUSION These findings suggest that VITT antibodies that cause PF4-independent platelet activation represent a unique subset of patients more likely to be associated with CVST, possibly due to the 2 different types of anti-PF4 antibodies.
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Affiliation(s)
- Angela Huynh
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nikola Ivetic
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rumi Clare
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Milena Hadzi-Tosev
- Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - James W Smith
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anna-Lise Bissola
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mercy Daka
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John G Kelton
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.
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22
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Suhaimi SNAA, Zaki IAH, Noordin ZM, Hussin NSM, Ming LC, Zulkifly HH. COVID-19 vaccine-induced immune thrombotic thrombocytopenia: a review. Clin Exp Vaccine Res 2023; 12:265-290. [PMID: 38025914 PMCID: PMC10655150 DOI: 10.7774/cevr.2023.12.4.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/20/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Rare but serious thrombotic incidents in relation to thrombocytopenia, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), have been observed since the vaccine rollout, particularly among replication-defective adenoviral vector-based severe acute respiratory syndrome coronavirus 2 vaccine recipients. Herein, we comprehensively reviewed and summarized reported studies of VITT following the coronavirus disease 2019 (COVID-19) vaccination to determine its prevalence, clinical characteristics, as well as its management. A literature search up to October 1, 2021 using PubMed and SCOPUS identified a combined total of 720 articles. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, after screening the titles and abstracts based on the eligibility criteria, the remaining 47 full-text articles were assessed for eligibility and 29 studies were included. Findings revealed that VITT cases are strongly related to viral vector-based vaccines, which are the AstraZeneca COVID-19 vaccine (95%) and the Janssen COVID-19 vaccine (4%), with much rarer reports involving messenger RNA-based vaccines such as the Moderna COVID-19 vaccine (0.2%) and the Pfizer COVID-19 vaccine (0.2%). The most severe manifestation of VITT is cerebral venous sinus thrombosis with 317 cases (70.4%) and the earliest primary symptom in the majority of cases is headache. Intravenous immunoglobulin and non-heparin anticoagulant are the main therapeutic options for managing immune responses and thrombosis, respectively. As there is emerging knowledge on and refinement of the published guidelines regarding VITT, this review may assist the medical communities in early VITT recognition, understanding the clinical presentations, diagnostic criteria as well as its management, offering a window of opportunity to VITT patients. Further larger sample size trials could further elucidate the link and safety profile.
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Affiliation(s)
| | - Izzati Abdul Halim Zaki
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
- Cardiology Therapeutics Research Group, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Zakiah Mohd Noordin
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
- Cardiology Therapeutics Research Group, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Nur Sabiha Md Hussin
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
| | - Hanis Hanum Zulkifly
- Department of Pharmacy Practice, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
- Cardiology Therapeutics Research Group, Universiti Teknologi MARA Selangor Branch, Bandar Puncak Alam, Malaysia
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23
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Joy M, Agrawal U, Fan X, Robertson C, Anand SN, Ordonez-Mena J, Byford R, Goudie R, Jamie G, Kar D, Williams J, Marsden GL, Tzortziou-Brown V, Sheikh SA, Hobbs FR, de Lusignan S. Thrombocytopenic, thromboembolic and haemorrhagic events following second dose with BNT162b2 and ChAdOx1: self-controlled case series analysis of the English national sentinel cohort. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100681. [PMID: 37671127 PMCID: PMC10477035 DOI: 10.1016/j.lanepe.2023.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
Background Thrombosis associated with thrombocytopenia was a matter of concern post first and second doses of BNT162b2 and ChAdOx1 COVID-19 vaccines. Therefore, it is important to investigate the risk of thrombocytopenic, thromboembolic and haemorrhagic events following a second dose of BNT162b2 and ChAdOx1 COVID-19 vaccines. Methods We conducted a large-scale self-controlled case series analysis, using routine primary care data linked to hospital data, among 12.3 million individuals (16 years old and above) in England. We used the nationally representative Oxford-Royal College of General Practitioners (RCGP) sentinel network database with baseline and risk periods between 8th December 2020 and 11th June 2022. We included individuals who received two vaccine (primary) doses of the BNT162b2 mRNA (Pfizer-BioNTech) and two vaccine doses of ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines in our analyses. We carried out a self-controlled case series (SCCS) analysis for each outcome using a conditional Poisson regression model with an offset for the length of risk period. We reported the incidence rate ratios (IRRs) and 95% confidence intervals (CI) of thrombocytopenic, thromboembolic (including arterial and venous events) and haemorrhagic events, in the period of 0-27 days after receiving a second dose of BNT162b2 or ChAdOx1 vaccines compared to the baseline period (14 or more days prior to first dose, 28 or more days after the second dose and the time between 28 or more days after the first and 14 or more days prior to the second dose). We adjusted for a range of potential confounders, including age, sex, comorbidities and deprivation. Findings Between December 8, 2020 and February 11, 2022, 6,306,306 individuals were vaccinated with two doses of BNT162b2 and 6,046,785 individuals were vaccinated with two doses of ChAdOx1. Compared to the baseline, our analysis show no increased risk of venous thromboembolic events (VTE) for both BNT162b2 (IRR 0.71, 95% CI: 0.65-0.770) and ChAdOx1 (IRR 0.91, 95% CI: 0.84-0.98); and similarly there was no increased risk for cerebral venous sinus thrombosis (CVST) for both BNT162b2 (IRR 0.87, 95% CI: 0.41-1.85) and ChAdOx1 (IRR 1.73, 95% CI: 0.82-3.68). We additionally report no difference in IRR for pulmonary embolus, and deep vein thrombosis, thrombocytopenia, including idiopathic thrombocytopenic purpura (ITP), and haemorrhagic events post second dose for both BNT162b2. Interpretation Reassuringly, we found no associations between increased risk of thrombocytopenic, thromboembolic and haemorrhagic events post vaccination with second dose for either of these vaccines. Funding Data and Connectivity: COVID-19 Vaccines Pharmacovigilance study.
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Affiliation(s)
- Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Sneha N. Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Jose Ordonez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | | | | | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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24
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Siegler JE, Dasgupta S, Abdalkader M, Penckofer M, Yaghi S, Nguyen TN. Cerebrovascular Disease in COVID-19. Viruses 2023; 15:1598. [PMID: 37515284 PMCID: PMC10385090 DOI: 10.3390/v15071598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Not in the history of transmissible illnesses has there been an infection as strongly associated with acute cerebrovascular disease as the novel human coronavirus SARS-CoV-2. While the risk of stroke has known associations with other viral infections, such as influenza and human immunodeficiency virus, the risk of ischemic and hemorrhagic stroke related to SARS-CoV-2 is unprecedented. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has so profoundly impacted psychosocial behaviors and modern medical care that we have witnessed shifts in epidemiology and have adapted our treatment practices to reduce transmission, address delayed diagnoses, and mitigate gaps in healthcare. In this narrative review, we summarize the history and impact of the COVID-19 pandemic on cerebrovascular disease, and lessons learned regarding the management of patients as we endure this period of human history.
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Affiliation(s)
- James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Savanna Dasgupta
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ 08103, USA
| | - Mohamad Abdalkader
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Mary Penckofer
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI 02912, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
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25
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Rau K, von Heeringen E, Bühler N, Wagenpfeil S, Becker SL, Schneitler S. Recipient-Reported Reactogenicity of Different SARS-CoV-2 Vaccination Regimens among Healthcare Professionals and Police Staff in Germany. Vaccines (Basel) 2023; 11:1147. [PMID: 37514963 PMCID: PMC10386135 DOI: 10.3390/vaccines11071147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023] Open
Abstract
The rapid availability of effective vaccines against SARS-CoV-2 was key during the COVID-19 pandemic. However, vaccine hesitancy and relatively low vaccine coverage rates among the general population and particularly vulnerable populations such as healthcare staff reduced the potential benefits of these vaccines. During the early phase of the pandemic, fear of vaccine-related adverse events was common among individuals who refused vaccination. Between March and May 2021, we comparatively assessed the self-reported reactogenicity of different SARS-CoV-2 prime-boost regimens using mRNA-based (BNT162b2 and mRNA-1273) and vector-based vaccines (ChAdOx1 nCoV-19) in (a) healthcare workers (HCW), and (b) police staff from southwest Germany. The majority of participants (71.8%; 1564/2176) received a homologous vaccination. Among HCW, 75.0% were female, whereas 70.0% of police staff were male. The most frequently reported reactions following the first vaccine administration were pain at the injection site (77.94%; 1696/2176), tiredness (51.75%; 1126/2176), and headache (40.44%; 880/2176), which were more commonly reported by HCW as compared to police staff. In homologous, mRNA-based and heterologous vaccination schedules, more reactions were reported after the second vaccine dose. We conclude that the frequency and intensity of self-perceived vaccine reactogenicity may differ between specific population groups and might be mitigated by tailored communication strategies.
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Affiliation(s)
- Katharina Rau
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Germany
| | | | - Nina Bühler
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, 66421 Homburg, Germany
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Germany
| | - Sophie Schneitler
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg, Germany
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, 42699 Solingen, Germany
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26
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Yang Y, Huang L. Neurological Disorders following COVID-19 Vaccination. Vaccines (Basel) 2023; 11:1114. [PMID: 37376503 DOI: 10.3390/vaccines11061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Nowadays, people all over the world have been receiving different types of coronavirus disease 2019 (COVID-19) vaccines. While their effectiveness has been well recognized, various post-vaccination disorders are not fully understood. In this review, we discuss neurological disorders related to vascular, immune, infectious, and functional factors following COVID-19 vaccination, and attempt to provide neuroscientists, psychiatrists, and vaccination staff with a reference for the diagnosis and treatment of these diseases. These disorders may present as a recurrence of previous neurological disorders or new-onset diseases. Their incidence rate, host and vaccine characteristics, clinical manifestations, treatment, and prognosis differ significantly. The pathogenesis of many of them remains unclear, and further studies are needed to provide more evidence. The incidence rate of severe neurological disorders is relatively low, most of which are reversible or treatable. Therefore, the benefits of vaccination outweigh the risk of COVID-19 infection, especially among fragile populations.
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Affiliation(s)
- Ying Yang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Lisu Huang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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Abstract
PURPOSE OF REVIEW This is an expert overview on recent literature about the complex relationship between coronavirus disease 2019 (COVID-19) and headache. RECENT FINDINGS Long COVID is a clinical syndrome characterized by the presence of persistent symptoms following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Headache is one of the most common symptoms and is described most often as throbbing pain, associated with photo and phonofobia and worsening with physical exercise. In acute COVID-19, headache is usually described as moderate or severe, diffuse and oppressive although sometimes it has been described with a migraine-like phenotype, especially in patients with a previous history of migraine. Headache intensity during acute phase seems to be the most important predictor of duration of headache over time. Some COVID-19 cases can be associated with cerebrovascular complications, and red flags of secondary headaches (e.g. new worsening or unresponsive headache, or new onset of neurological focal signs) should be urgently investigated with imaging. Treatment goals are the reduction of number and intensity of headache crises, and the prevention of chronic forms. SUMMARY This review can help clinicians to approach patients with headache and infection from SARS-CoV-2, with particular attention to persistent headache in long COVID.
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Affiliation(s)
- Claudio Tana
- Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, Chieti
| | - Maria Adele Giamberardino
- Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, Chieti
- Department of Medicine and Science of Aging and CAST, G. D'Annunzio University of Chieti
| | - Paolo Martelletti
- Internal Medicine and Emergency Medicine, Sant' Andrea Hospital, Sapienza University, Rome, Italy
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28
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Carletti F, Vilela P, Jäger HR. Imaging Approach to Venous Sinus Thrombosis. Radiol Clin North Am 2023; 61:501-519. [PMID: 36931766 DOI: 10.1016/j.rcl.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease caused by an occlusion of the cerebral venous sinuses or cortical veins. It has a favorable prognosis if diagnosed and treated early. CVT can be difficult to diagnose on clinical grounds, and imaging plays a key role. We discuss clinical features and provide an overview of current neuroimaging methods and findings in CTV.
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Affiliation(s)
- Francesco Carletti
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Pedro Vilela
- Neuroradiology Department. Lisbon Western University Center (Centro Hospitalar Lisboa Ocidental -CHLO), Lisbon Portugal; Imaging Department, Hospital da Luz Lisbon, Portugal
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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29
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Louis DW, Saad M, Vijayakumar S, Ilyas S, Kokkirala A, Aronow HD. The Cardiovascular Manifestations of COVID-19. Heart Fail Clin 2023; 19:153-161. [PMID: 36863807 PMCID: PMC9973545 DOI: 10.1016/j.hfc.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.
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Affiliation(s)
- David W. Louis
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Marwan Saad
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Shilpa Vijayakumar
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Suleman Ilyas
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Aravind Kokkirala
- United States Department of Veterans Affairs Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Herbert D. Aronow
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA,Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA,Corresponding author. 593 Eddy Street, RIH APC 730, Providence, RI 02903
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30
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Investigation of Neurological Complications after COVID-19 Vaccination: Report of the Clinical Scenarios and Review of the Literature. Vaccines (Basel) 2023; 11:vaccines11020425. [PMID: 36851302 PMCID: PMC9966113 DOI: 10.3390/vaccines11020425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in 2019 and became a pandemic in 2020. Since then, vaccines have been approved to prevent severe illness. However, vaccines are associated with the risk of neurological complications ranging from mild to severe. Severe complications such as vaccine-induced immune thrombotic thrombocytopenia (VITT) associated with acute ischaemic stroke have been reported as rare complications post-COVID-19 vaccination. During the pandemic era, VITT evaluation is needed in cases with a history of vaccination within the last month prior to the event. Cerebral venous sinus thrombosis (CVST) should be suspected in patients following immunization with persistent headaches who are unresponsive to analgesics. In this article, we investigated neurological complications after COVID-19 vaccination and provided more subsequent related clinical studies of accurate diagnosis, pathophysiological mechanisms, incidence, outcome, and management.
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31
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Krzywicka K, Aguiar de Sousa D, Cordonnier C, Bode FJ, Field TS, Michalski D, Pelz J, Skjelland M, Wiedmann M, Zimmermann J, Wittstock M, Zanotti B, Ciccone A, Bandettini di Poggio M, Borhani-Haghighi A, Chatterton S, Aujayeb A, Devroye A, Dizonno V, Geeraerts T, Giammello F, Günther A, Ichaporia NR, Kleinig T, Kristoffersen ES, Lemmens R, De Maistre E, Mirzaasgari Z, Payen JF, Putaala J, Petruzzellis M, Raposo N, Sadeghi-Hokmabadi E, Schoenenberger S, Umaiorubahan M, Sylaja PN, van de Munckhof A, Sánchez van Kammen M, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Kruip MJHA, Arauz A, Conforto AB, Aaron S, Middeldorp S, Tatlisumak T, Arnold M, Coutinho JM, Ferro JM. Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur J Neurol 2023; 30:1335-1345. [PMID: 36773014 DOI: 10.1111/ene.15735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored. METHODS Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included. RESULTS Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p < 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p < 0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent. CONCLUSIONS Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
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Affiliation(s)
- Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Center, Lisbon, Portugal.,CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Charlotte Cordonnier
- INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, University of Lille, Lille, France
| | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Markus Wiedmann
- Department of Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Bruno Zanotti
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Alfonso Ciccone
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | | | | | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXVI Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Stroke Unit, Department of Clinical and Experimental Medicine, Polyclinic Hospital G. Martino, Messina, Italy
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Espen S Kristoffersen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Emmanuel De Maistre
- Laboratoire d'Hématologie-Hémostase, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Jean-Francois Payen
- Department of Anaesthesia and Intensive Care, Grenoble Alpes University Hospital, and Grenoble Alpes University, Grenoble Institut des Neurosciences, INSERM U1216, Grenoble, France
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Elyar Sadeghi-Hokmabadi
- Department of Neurology, Imam-Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Padmavathy N Sylaja
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany.,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Antonio Arauz
- National Institute of Neurology and Surgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Doubrovinskaia S, Mooshage CM, Seliger C, Lorenz H, Nagel S, Lehnert P, Purrucker J, Wildemann B, Bendszus M, Wick W, Schönenberger S, Kaulen LD. Neurological autoimmune diseases following vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A follow-up study. Eur J Neurol 2023; 30:463-473. [PMID: 36259114 PMCID: PMC9874608 DOI: 10.1111/ene.15602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Population-based studies suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger neurological autoimmunity including immune-mediated thrombotic thrombocytopenia. Long-term characterization of cases is warranted to facilitate patient care and inform vaccine-hesitant individuals. METHODS In this single-center prospective case study with a median follow-up of 387 days long-term clinical, laboratory and imaging characteristics of patients with neurological autoimmunity diagnosed in temporal association (≤6 weeks) with SARS-CoV-2 vaccinations are reported. RESULTS Follow-up data were available for 20 cases (central nervous system demyelinating diseases n = 8, inflammatory peripheral neuropathies n = 4, vaccine-induced immune thrombotic thrombocytopenia n = 3, myositis n = 2, myasthenia n = 1, limbic encephalitis n = 1, giant cell arteritis n = 1). Following therapy, the overall disability level improved (median modified Rankin Scale at diagnosis 3 vs. 1 at follow-up). The condition of two patients worsened despite immunosuppressants possibly related to their autoimmune diagnoses (limbic encephalitis n = 1, giant cell arteritis n = 1). At 12 months' follow-up, 12 patients achieved complete clinical remissions with partial responses in five and stable disease in one case. Correspondingly, autoimmune antibodies were non-detectable or titers had significantly lowered in all, and repeat imaging revealed radiological responses in most cases. Under vigilant monitoring 15 patients from our cohort underwent additional SARS-CoV-2 vaccinations (BNT162b2 n = 12, mRNA-1273 n = 3). Most patients (n = 11) received different vaccines than prior to diagnosis of neurological autoimmunity. Except for one short-lasting relapse, which responded well to steroids, re-vaccinations were well tolerated. CONCLUSIONS In this study long-term characteristics of neurological autoimmunity encountered after SARS-CoV-2 vaccinations are defined. Outcome was favorable in most cases. Re-vaccinations were well tolerated and should be considered on an individual risk/benefit analysis.
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Affiliation(s)
- Sofia Doubrovinskaia
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Christoph M. Mooshage
- Department of NeuroradiologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Corinna Seliger
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Hanns‐Martin Lorenz
- Division of RheumatologyDepartment of Internal Medicine V, University Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Simon Nagel
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
- Department of NeurologyHospital LudwigshafenLudwigshafenGermany
| | - Pascal Lehnert
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Jan Purrucker
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Brigitte Wildemann
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Martin Bendszus
- Department of NeuroradiologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Wolfgang Wick
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Silvia Schönenberger
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Leon D. Kaulen
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
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Huang P, Zhang LY, Tan YY, Chen SD. Links between COVID-19 and Parkinson's disease/Alzheimer's disease: reciprocal impacts, medical care strategies and underlying mechanisms. Transl Neurodegener 2023; 12:5. [PMID: 36717892 PMCID: PMC9885419 DOI: 10.1186/s40035-023-00337-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/12/2023] [Indexed: 01/31/2023] Open
Abstract
The impact of coronavirus disease 2019 (COVID-19) pandemic on patients with neurodegenerative diseases and the specific neurological manifestations of COVID-19 have aroused great interest. However, there are still many issues of concern to be clarified. Therefore, we review the current literature on the complex relationship between COVID-19 and neurodegenerative diseases with an emphasis on Parkinson's disease (PD) and Alzheimer's disease (AD). We summarize the impact of COVID-19 infection on symptom severity, disease progression, and mortality rate of PD and AD, and discuss whether COVID-19 infection could trigger PD and AD. In addition, the susceptibility to and the prognosis of COVID-19 in PD patients and AD patients are also included. In order to achieve better management of PD and AD patients, modifications of care strategies, specific drug therapies, and vaccines during the pandemic are also listed. At last, mechanisms underlying the link of COVID-19 with PD and AD are reviewed.
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Affiliation(s)
- Pei Huang
- grid.16821.3c0000 0004 0368 8293Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Lin-Yuan Zhang
- grid.412478.c0000 0004 1760 4628Department of Neurology, Shanghai General Hospital, Shanghai, 200080 China
| | - Yu-Yan Tan
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Lab for Translational Research of Neurodegenerative Diseases, Shanghai Institute for Advanced Immunochemical Studies (SIAIS), Shanghai Tech University, Shanghai, 201210, China.
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Sallard E, Zhang W, Aydin M, Schröer K, Ehrhardt A. The Adenovirus Vector Platform: Novel Insights into Rational Vector Design and Lessons Learned from the COVID-19 Vaccine. Viruses 2023; 15:204. [PMID: 36680244 PMCID: PMC9862123 DOI: 10.3390/v15010204] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
The adenovirus vector platform remains one of the most efficient toolboxes for generation of transfer vehicles used in gene therapy and virotherapy to treat tumors, as well as vaccines to protect from infectious diseases. The adenovirus genome and capsids can be modified using highly efficient techniques, and vectors can be produced at high titers, which facilitates their rapid adaptation to current needs and disease applications. Over recent years, the adenovirus vector platform has been in the center of attention for vaccine development against the ongoing coronavirus SARS-CoV-2/COVID-19 pandemic. The worldwide deployment of these vaccines has greatly deepened the knowledge on virus-host interactions and highlighted the need to further improve the effectiveness and safety not only of adenovirus-based vaccines but also of gene therapy and oncolytic virotherapy vectors. Based on the current evidence, we discuss here how adenoviral vectors can be further improved by intelligent molecular design. This review covers the full spectrum of state-of-the-art strategies to avoid vector-induced side effects ranging from the vectorization of non-canonical adenovirus types to novel genome engineering techniques.
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Affiliation(s)
- Erwan Sallard
- Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), School of Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Wenli Zhang
- Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), School of Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Malik Aydin
- Laboratory of Experimental Pediatric Pneumology and Allergology, Center for Biomedical Education and Research, School of Life Sciences (ZBAF), Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Katrin Schröer
- Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), School of Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
| | - Anja Ehrhardt
- Virology and Microbiology, Center for Biomedical Education and Research (ZBAF), School of Medicine, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
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35
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Venier LM, Clerici B, Bissola AL, Modi D, Jevtic SD, Radford M, Mahamad S, Nazy I, Arnold DM. Unique features of vaccine-induced immune thrombotic thrombocytopenia; a new anti-platelet factor 4 antibody-mediated disorder. Int J Hematol 2023; 117:341-348. [PMID: 36574172 PMCID: PMC9793819 DOI: 10.1007/s12185-022-03516-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a highly prothrombotic disorder caused by anti-PF4 antibodies that activate platelets and neutrophils, leading to thrombosis. Heparin-induced thrombocytopenia (HIT) is a related anti-PF4 mediated disorder, with similar pathophysiology and clinical manifestations but different triggers (i.e., heparin vs adenoviral vector vaccine). Clinically, both HIT and VITT typically present with thrombocytopenia and thrombosis, although the risk of thrombosis is significantly higher in VITT, and the thromboses occur in unusual anatomical sites (e.g., cerebral venous sinus thrombosis and hepatic vein thrombosis). The diagnostic accuracy of available laboratory testing differs between HIT and VITT; for VITT, ELISAs have better specificity compared to HIT and platelet activation assays require the addition of PF4. Treatment of VITT and HIT is anticoagulation non-heparin anticoagulants; however, heparin may be considered for VITT if no other option is available.
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Affiliation(s)
- Laura M. Venier
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Bianca Clerici
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy ,McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON L8S 4K1 Canada
| | - Anna-Lise Bissola
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON Canada ,Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON Canada
| | - Dimpy Modi
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON L8S 4K1 Canada
| | - Stefan D. Jevtic
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON Canada
| | - Michael Radford
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON Canada
| | - Syed Mahamad
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON L8S 4K1 Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON Canada ,McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON L8S 4K1 Canada
| | - Donald M. Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON Canada ,McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON L8S 4K1 Canada
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36
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Shapiro JR, Roberts CW, Arcovio K, Reade L, Klein SL, Dhakal S. Effects of Biological Sex and Pregnancy on SARS-CoV-2 Pathogenesis and Vaccine Outcomes. Curr Top Microbiol Immunol 2023; 441:75-110. [PMID: 37695426 DOI: 10.1007/978-3-031-35139-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
SARS-CoV-2 is the causative agent of COVID-19 in humans and has resulted in the death of millions of people worldwide. Similar numbers of infections have been documented in males and females; males, however, are more likely than females to be hospitalized, require intensive care unit, or die from COVID-19. The mechanisms that account for this are multi-factorial and are likely to include differential expression of ACE2 and TMPRSS2 molecules that are required for viral entry into hosts cells and sex differences in the immune response, which are due to modulation of cellular functions by sex hormones and differences in chromosomal gene expression. Furthermore, as comorbidities are also associated with poorer outcomes to SARS-CoV-2 infection and several comorbidities are overrepresented in males, these are also likely to contribute to the observed sex differences. Despite their relative better prognosis following infection with SARS-CoV-2, females do have poorer outcomes during pregnancy. This is likely to be due to pregnancy-induced changes in the immune system that adversely affect viral immunity and disruption of the renin-angiotensin system. Importantly, vaccination reduces the severity of disease in males and females, including pregnant females, and there is no evidence that vaccination has any adverse effects on the outcomes of pregnancy.
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Affiliation(s)
- Janna R Shapiro
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Craig W Roberts
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Kasandra Arcovio
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Lisa Reade
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - Sabra L Klein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Santosh Dhakal
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA.
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37
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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38
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Yepes M. Neurological Complications of SARS-CoV-2 Infection and COVID-19 Vaccines: From Molecular Mechanisms to Clinical Manifestations. Curr Drug Targets 2022; 23:1620-1638. [PMID: 36121081 DOI: 10.2174/1389450123666220919123029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is an infectious disease, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), that reached pandemic proportions in 2020. Despite the fact that it was initially characterized by pneumonia and acute respiratory distress syndrome, it is now clear that the nervous system is also compromised in one third of these patients. Indeed, a significant proportion of COVID-19 patients suffer nervous system damage via a plethora of mechanisms including hypoxia, coagulopathy, immune response to the virus, and the direct effect of SARS-CoV-2 on endothelial cells, neurons, astrocytes, pericytes and microglia. Additionally, a low number of previously healthy individuals develop a variety of neurological complications after receiving COVID-19 vaccines and a large proportion of COVID-19 survivors experience longlasting neuropsychiatric symptoms. In conclusion, COVID-19 is also a neurological disease, and the direct and indirect effects of the virus on the nervous system have a significant impact on the morbidity and mortality of these patients. Here we will use the concept of the neurovascular unit, assembled by endothelial cells, basement membrane, perivascular astrocytes, neurons and microglia, to review the effects of SARS-CoV-2 in the nervous system. We will then use this information to review data published to this date on the neurological manifestations of COVID-19, the post- COVID syndrome and COVID-19 vaccines.
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Affiliation(s)
- Manuel Yepes
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Atlanta, GA, USA.,Department of Neurology & Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Veterans Affairs Medical Center, Atlanta, GA, USA
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39
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Buoninfante A, Andeweg A, Baker AT, Borad M, Crawford N, Dogné JM, Garcia-Azorin D, Greinacher A, Helfand R, Hviid A, Kochanek S, López-Fauqued M, Nazy I, Padmanabhan A, Pavord S, Prieto-Alhambra D, Tran H, Wandel Liminga U, Cavaleri M. Understanding thrombosis with thrombocytopenia syndrome after COVID-19 vaccination. NPJ Vaccines 2022; 7:141. [PMID: 36351906 PMCID: PMC9643955 DOI: 10.1038/s41541-022-00569-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alessandra Buoninfante
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands
| | - Arno Andeweg
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands
| | - Alexander T. Baker
- grid.417468.80000 0000 8875 6339Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ 85054 USA ,grid.5600.30000 0001 0807 5670Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Mitesh Borad
- grid.417467.70000 0004 0443 9942Mayo Clinic Cancer Center, Phoenix, AZ 85054 USA
| | - Nigel Crawford
- grid.1008.90000 0001 2179 088XRoyal Children’s Hospital, Murdoch Children’s Research Institute, Department Paediatrics, The University of Melbourne, Melbourne, VIC Australia
| | - Jean-Michel Dogné
- grid.6520.10000 0001 2242 8479Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium ,grid.452397.eEMA Pharmacovigilance Risk Assessment Committee member, Amsterdam, The Netherlands
| | - David Garcia-Azorin
- grid.411057.60000 0000 9274 367XDepartment of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Andreas Greinacher
- grid.5603.0Department of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rita Helfand
- grid.416738.f0000 0001 2163 0069National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA ,grid.3575.40000000121633745WHO’s Global Advisory Committee on Vaccine Safety, WHO, Geneva, Switzerland
| | - Anders Hviid
- grid.5254.60000 0001 0674 042XPharmacovigilance Research Center, Department of Drug Development and Clinical Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.6203.70000 0004 0417 4147Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Stefan Kochanek
- grid.6582.90000 0004 1936 9748Department of Gene Therapy, University of Ulm, Ulm, Germany
| | - Marta López-Fauqued
- grid.452397.eVaccines and Therapies for Infectious Diseases, European Medicines Agency, Amsterdam, the Netherlands
| | - Ishac Nazy
- grid.25073.330000 0004 1936 8227McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON Canada
| | - Anand Padmanabhan
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Sue Pavord
- grid.410556.30000 0001 0440 1440Department Hematology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, UK
| | - Daniel Prieto-Alhambra
- grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK ,grid.5645.2000000040459992XDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Huyen Tran
- grid.1623.60000 0004 0432 511XDepartment of Clinical Haematology, The Alfred Hospital, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, VIC Australia
| | - Ulla Wandel Liminga
- grid.452397.eEMA Pharmacovigilance Risk Assessment Committee member, Amsterdam, The Netherlands ,grid.415001.10000 0004 0475 6278Medical Products Agency, Uppsala, Sweden
| | - Marco Cavaleri
- grid.452397.eHealth Threats and Vaccines Strategy, European Medicines Agency, Amsterdam, the Netherlands ,grid.452397.eEMA Emergency Task Force Chair, Amsterdam, The Netherlands
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Salih F, Schönborn L, Endres M, Greinacher A. Immunvermittelte Sinus- und Hirnvenenthrombosen: VITT und
prä-VITT als Modellerkrankung. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1936-3123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ZusammenfassungIn diesem Übersichtsartikel beschreiben wir die klinischen und
paraklinischen Charakteristika der Vakzin-induzierten immunthrombotischen
Thrombozytopenie (VITT) und fassen den gegenwärtigen Kenntnisstand zur
Pathogenese zusammen. Bei der VITT bilden sich 5–20 Tage nach einer
Impfung mit einem Adenovirus-vektorbasiertem SARS-CoV-2-Vakzin (AstraZeneca oder
Johnson & Johnson) lebensbedrohliche Thrombosen aus, vor allem in den
zerebralen Sinus und Hirnvenen. Laborchemisch zeigt sich eine typische
Thrombozytopenie mit erhöhten D-Dimeren. Der Pathogenese liegen
immunologische Prozesse zugrunde, die Ähnlichkeiten mit der
Heparin-induzierten Thrombozytopenie aufweisen: so geht die VITT mit
hochtitrigem Immunoglobulin G gegen das thrombozytäre Protein
Plättchenfaktor 4 (PF4) einher. Durch die Interaktion mit dem Impfstoff
wird PF4 so verändert, dass es von Antikörper-produzierenden
Zellen des Immunsystems erkannt wird. Die so produzierten
Anti-PF4-Antikörper führen über thrombozytäre
FcγIIa-Rezeptoren zu einer Plättchenaktivierung. Der Nachweis
plättchenaktivierender Anti-PF4-Antikörper bestätigt die
Diagnose einer VITT. Antikoagulanzien, die die Bildung von Thrombin oder
Thrombin selbst blockieren und hochdosiertes i. v.-Immunglobulin G, das
die Fcγ-Rezeptor-vermittelte Zellaktivierung inhibiert, stellen die
wirksame und kausale Behandlung der VITT dar. Bei Patienten mit katastrophalem
Verlauf kann ein Plasmaaustausch versucht werden. Bei einigen Patienten ist ein
prä-VITT Syndrom als Prodromalstadium zu beoachten, das sich
typischerweise mit Kopfschmerzen manifestieren kann und dessen frühe
Behandlung hilft, thrombotische Komplikationen zu vermeiden. Die spezifische
Dynamik der VITT-assozierten Immunreaktion entspricht einer transienten,
sekundären Immunantwort. Aktuelle Studien gehen der Frage nach, wie PF4
an unterschiedliche adenovirale Proteine bindet und beleuchten die Rolle von
anderen Impfstoff-Bestandteilen als potentielle Liganden für die
PF4-Bindung. Einige dieser Faktoren sind auch an der Etablierung eines
proinflammatorischen Milieus („danger signal“) beteiligt, das
unmittelbar nach der Impfung die 1. Phase der VITT-Pathogenese triggert. Sobald
in der 2. Phase der VITT-Pathogenese hohe Titer von Anti-PF4-Antikörper
gebildet sind, aktivieren diese neben Thrombozyten auch Granulozyten. In einem
als NETose (von „neutrophil extracellular traps“) bezeichneten
Prozess setzen aktivierte Granulozyten dabei DNA frei, mit der PF4 weitere
Komplexe bildet, an die Anti-PF4-Antikörper binden. Dies
verstärkt die Fcγ-Rezeptor-vermittelte Zellaktivierung weiter
mit der Folge einer ausgeprägten Thrombin-Bildung. Zum Ende des Artikels
geben wir einen Ausblick, welchen Einfluss die bisherigen Erkenntnisse zur VITT
auf weitere globale Impfkampagnen gegen SARS-CoV-2 haben und beleuchten, wie
Anti-PF4-Antikörper jenseits von VITT und HIT auch eine Rolle bei
seltenen Erkrankungen spielen, die mit rezidivierenden venösen und
arteriellen Thrombosen einhergehen.
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Affiliation(s)
- Farid Salih
- Klinik für Neurologie mit Experimenteller Neurologie,
Charité Universitätsmedizin Berlin, Berlin,
Germany
| | - Linda Schönborn
- Institut für Transfusionsmedizin, Universitätsmedizin
Greifswald, Greifswald, Germany
| | - Matthias Endres
- Klinik für Neurologie mit Experimenteller Neurologie,
Charité Universitätsmedizin Berlin, Berlin,
Germany
| | - Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin
Greifswald, Greifswald, Germany
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41
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Studie untersucht immunthrombotische
Thrombozytopenie
nach
SARS-CoV-2-Impfung. FORTSCHRITTE DER NEUROLOGIE · PSYCHIATRIE 2022. [DOI: 10.1055/a-1799-5291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nachdem über zerebrale Sinusvenenthrombosen (cerebral venous sinus
thrombosis, CVST) in Kombination mit dem Thrombozytopeniesyndrom (TTS), die
innerhalb weniger Tage nach der Impfung mit den SARS-CoV-2-Impfstoffen ChAdOx1
nCov-19 (Oxford-AstraZeneca) und Ad26.COV2.S (Janssen/Johnson &
Johnson) auftraten, berichtet wurde, schränkten mehrere Länder
die Verwendung der Impfstoffe ein. Dabei ist bislang unklar, ob
tatsächlich ein Zusammenhang besteht.
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Hsu JL, Chin SC, Cheng MH, Wu YR, Ro A, Ro LS. Postpartum Spinal Cord Infarction: A Case Report and Review of the Literature. MEDICINES (BASEL, SWITZERLAND) 2022; 9:54. [PMID: 36355059 PMCID: PMC9698876 DOI: 10.3390/medicines9110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Background: Postpartum spinal cord infarction is a very rare disease. Only two cases have been reported in the English literature. Methods: We reported a 26 year old female who received second doses of the mRNA-1273 vaccine 52 days before delivery. She presented as sudden onset of paraplegia, sensory level, and sphincter incontinence at postpartum period. No history of heparin exposure was noted. Imaging findings confirmed the T10-11 level infarction and her anti-human heparin platelet factor 4 (anti-PF4) antibody was positive. After 7 days of dexamethasone therapy, her paraplegia and urinary incontinence gradually improved. Results: The CT angiography (CTA) of the artery of Adamkiewicz (Aka) showed tandem narrowing, most conspicuous at the T10-11 level, which was presumably due to partial occlusion of the arteriolar lumen. The thoracolumbar spine magnetic resonance imaging with contrast medium showed owl's eyes sign at the T10 and T11 levels. We compared our case with two other case reports from the literature. Conclusions: Post-partum spinal cord infarction with positive anti-PF4 antibody and relatively thrombocytopenia are the characteristics of our case.
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Affiliation(s)
- Jung-Lung Hsu
- Department of Neurology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei City 236, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Shy-Chyi Chin
- Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48105, USA
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Aileen Ro
- Department of Obstetrics and Gynecology, College of Medicine, Linkou Chang Gung Memorial Hospital and Chang-Gung University, Taoyuan 333, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
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Stefanou MI, Palaiodimou L, Aguiar de Sousa D, Theodorou A, Bakola E, Katsaros DE, Halvatsiotis P, Tzavellas E, Naska A, Coutinho JM, Sandset EC, Giamarellos-Bourboulis EJ, Tsivgoulis G. Acute Arterial Ischemic Stroke Following COVID-19 Vaccination: A Systematic Review and Meta-analysis. Neurology 2022; 99:e1465-e1474. [PMID: 36002319 DOI: 10.1212/wnl.0000000000200996] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute arterial ischemic stroke (AIS) has been reported as a rare adverse event following coronavirus disease 2019 (COVID-19) vaccination with messenger RNA (mRNA) or viral vector vaccines. However, data are sparse regarding the risk of postvaccination AIS and its potential association with thrombotic-thrombocytopenia syndrome (TTS). METHODS A systematic review and meta-analysis of randomized controlled clinical trials (RCTs), pharmacovigilance registries, registry-based studies, observational cohorts, and case-series was performed with the aim to calculate the following: (1) the pooled proportion of patients presenting with AIS following COVID-19 vaccination; (2) the prevalence of AIS after mRNA and vector-based vaccination; and (3) the proportion of TTS among postvaccination AIS cases. Patient characteristics were assessed as secondary outcomes. RESULTS Two RCTs, 3 cohort studies, and 11 registry-based studies comprising 17,481 AIS cases among 782,989,363 COVID-19 vaccinations were included in the meta-analysis. The pooled proportion of AIS following exposure to any COVID-19 vaccine type was 4.7 cases per 100,000 vaccinations (95% CI 2.2-8.1; I 2 = 99.9%). The pooled proportion of AIS following mRNA vaccination (9.2 cases per 100,000 vaccinations; 95% CI 2.5-19.3; I 2 = 99.9%) did not differ compared with adenovirus-based vaccination (2.9 cases per 100,000 vaccinations; 95% CI 0.3-7.8; I 2 = 99.9%). No differences regarding demographics were disclosed between patients with AIS following mRNA-based or vector-based vaccination. The pooled proportion of TTS among postvaccination AIS cases was 3.1% (95% CI 0.7%-7.2%; I 2 = 78.8%). DISCUSSION The pooled proportion of AIS following COVID-19 vaccination is comparable with the prevalence of AIS in the general population and much lower than the AIS prevalence among severe acute respiratory syndrome coronavirus 2-infected patients. TTS is very uncommonly reported in patients with AIS following COVID-19 vaccination.
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Affiliation(s)
- Maria-Ioanna Stefanou
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Lina Palaiodimou
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Diana Aguiar de Sousa
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Aikaterini Theodorou
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Eleni Bakola
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Dimitrios Eleftherios Katsaros
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Panagiotis Halvatsiotis
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Elias Tzavellas
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Androniki Naska
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Jonathan M Coutinho
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Else Charlotte Sandset
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Evangelos J Giamarellos-Bourboulis
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis
| | - Georgios Tsivgoulis
- From the Second Department of Neurology (M.-I.S., L.P., A.T., E.B., D.E.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurosciences (Neurology) (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal; Second Department of Internal Medicine-Propaedeutic and Diabetes Center (P.H.), Medical School, University General Hospital "Attikon," First Department of Psychiatry (E.T.), Aiginition Hospital, and Department of Hygiene (A.N.), Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (J.M.C.), Amsterdam University Medical Centers, the Netherlands; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital, Norway; 4th Department of Internal Medicine (E.J.G.-B.), Medical School, National and Kapodistrian University of Athens, Greece; and Department of Neurology (G.T.), University of Tennessee Health Science Center, Memphis.
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44
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Simpkins AN, Cheng S. COVID-19 Exposures, Vaccines, and Acute Ischemic Stroke Risk: On Balance and in Balance. Neurology 2022; 99:597-598. [PMID: 36002318 DOI: 10.1212/wnl.0000000000201109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexis N Simpkins
- From the Department of Neurology (A.N.S.), Cedars-Sinai Medical Center; and Department of Cardiology (S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Susan Cheng
- From the Department of Neurology (A.N.S.), Cedars-Sinai Medical Center; and Department of Cardiology (S.C.), Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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45
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van de Munckhof A, Lindgren E, Kleinig TJ, Field TS, Cordonnier C, Krzywicka K, Poli S, Sánchez van Kammen M, Borhani-Haghighi A, Lemmens R, Scutelnic A, Ciccone A, Gattringer T, Wittstock M, Dizonno V, Devroye A, Elkady A, Günther A, Cervera A, Mengel A, Chew BLA, Buck B, Zanferrari C, Garcia-Esperon C, Jacobi C, Soriano C, Michalski D, Zamani Z, Blacquiere D, Johansson E, Cuadrado-Godia E, Vuillier F, Bode FJ, Caparros F, Maier F, Tsivgoulis G, Katzberg HD, Duan J, Burrow J, Pelz J, Mbroh J, Oen J, Schouten J, Zimmermann J, Ng K, Garambois K, Petruzzellis M, Carvalho Dias M, Ghiasian M, Romoli M, Miranda M, Wronski M, Skjelland M, Almasi-Dooghaee M, Cuisenier P, Murphy S, Timsit S, Coutts SB, Schönenberger S, Nagel S, Hiltunen S, Chatterton S, Cox T, Bartsch T, Shaygannejad V, Mirzaasgari Z, Middeldorp S, Levi MM, Kremer Hovinga JA, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, Aguiar de Sousa D, Ferro JM, Coutinho JM. Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase. Stroke 2022; 53:3206-3210. [PMID: 36082668 PMCID: PMC9508952 DOI: 10.1161/strokeaha.122.039575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia (T.J.K.)
| | - Thalia S Field
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | | | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy (A. Ciccone)
| | | | - Matthias Wittstock
- Department of Neurology, University Hospital Rostock, Germany (M. Wittstock)
| | - Vanessa Dizonno
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia (A.E.)
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Germany (A.G.)
| | - Alvaro Cervera
- Royal Darwin Hospital, Darwin, Northern Territory, Australia (A. Cervera)
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.)
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Canada (B.B.)
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Italy (C.Z.)
| | - Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Christian Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany (C.J.)
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain (C.S.)
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Zohreh Zamani
- Department of Neurology, Firoozabadi Hospital, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (Z.Z.)
| | | | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine (WCMM), Umeå University, Sweden (E.J.)
| | - Elisa Cuadrado-Godia
- Department of Neurology, University Hospital del Mar, Barcelona, Spain (E.C.-G.)
| | | | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - François Caparros
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Germany (F.M.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T.)
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Canada (H.D.K.)
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China (J.D.)
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia (J.B.)
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Joshua Mbroh
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Joyce Oen
- Department of Neurology, Antonius Ziekenhuis, Sneek, the Netherlands (J.O.)
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, the Netherlands (J.S.)
| | - Julian Zimmermann
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - Karl Ng
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Katia Garambois
- Department of Neurology, CHU Grenoble Alpes, France (K.G., P.C.)
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Italy (M.P.)
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Portugal (M.C.D.)
| | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Iran (M.G.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M.R.)
| | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal (M.M.)
| | - Miriam Wronski
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway (M.S.)
| | | | | | - Seán Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, UCD School of Medicine and RCSI Medical School, Dublin, Ireland (S. Murphy)
| | - Serge Timsit
- Department of Neurology, Stroke Unit, Hôpital de la Cavale Blanche, CHRU de Brest (University Hospital), Université de Bretagne Occidentale, Inserm 1078, Brest, France (S.T.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Canada (S.B.C.)
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Germany (S.S., S.N.)
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, United Kingdom (T.C.)
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany (T.B.)
| | - Vahid Shaygannejad
- Isfahan University of Medical Sciences (IUMS), Isfahan Neurosciences Research Center (INRC), Iran (V.S.).,Department of Internal (INRC), Iran (V.S.)
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (M.A.-D., Z.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (S. Middeldorp)
| | - Marcel M Levi
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (M.M.L.).,National Institute for Health Research, University College London Hospitals (UCLH), Biomedical Research Centre, London, United Kingdom (M.M.L.)
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.A.K.H.)
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Centre, Portugal (D.A.d.S.).,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
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Khan Z, Besis G, Candilio L. COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia With Venous and Arterial Thrombosis: A Case Report. Cureus 2022; 14:e28535. [PMID: 36185940 PMCID: PMC9518638 DOI: 10.7759/cureus.28535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Coronavirus disease 19 pandemic has put tremendous pressure on health systems and has caused significant morbidity and mortality throughout the world. Vaccination program against COVID-19 has been effective despite repeated outbreaks across the globe. It was however reported that COVID-19 vaccines in particular, the Oxford-AstraZeneca COVID-19 vaccine (AZD1222) was temporarily suspended by some European countries due to risk of thrombosis. COVID-19 is a prothrombotic condition and is associated with venous thromboembolism mainly. The condition can be challenging to diagnose due to its diagnostic variation. Cases of vaccine-induced thrombotic thrombocytopaenia has been reported in several countries. COVID-19 can also cause vaccine-induced thrombosis without thrombocytopaenia. The thrombotic events can affect different parts of the body including brain, heart, and peripheral vessels. We present a case of 54-year-old patient who presented with chest and abdominal pain for 12 hours and evidence of infero-lateral ST segment elevation on electrocardiogram. Patient received COVID-19 AstraZeneca vaccine 10 days prior to admission. Coronary angiography (CAG) showed occlusion of the proximal to mid part of the right coronary artery (RCA) distal to a large Right Ventricular branch with high thrombotic burden and multiple attempts at aspiration of the thrombus resulted in partial restoration of the flow to right coronary artery.
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47
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Esmaeilzadeh A, Maleki AJ, Moradi A, Siahmansouri A, Yavari MJ, Karami P, Elahi R. Major severe acute respiratory coronavirus-2 (SARS-CoV-2) vaccine-associated adverse effects; benefits outweigh the risks. Expert Rev Vaccines 2022; 21:1377-1394. [DOI: 10.1080/14760584.2022.2116008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Abdolreza Esmaeilzadeh
- Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran
- Cancer Gene Therapy Research Center (CGRC), Zanjan University of Medical Sciences, Zanjan, Iran
| | - Armin Jahani Maleki
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amirhosein Moradi
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Siahmansouri
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Parsa Karami
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Elahi
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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48
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Carotid free-floating thrombus during COVID-19 vaccine era: causality or not? Neurol Sci 2022; 43:6179-6183. [PMID: 35921016 PMCID: PMC9362674 DOI: 10.1007/s10072-022-06307-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
Carotid free-floating thrombus (FFT) is very rarely diagnosed in patients with acute ischemic stroke. It is a real clinical emergency due to the significant risk of death associated with thromboembolic complications. Herein, we present three patients with ischemic stroke caused by carotid FFT after less than 20 days from administration of mRNA vaccine BNT162b1 (Pfizer/BioNTech) for Severe Acute Respiratory Syndrome—CoronaVirus 2 (SARS-CoV-2). To our knowledge, these are the first cases reporting carotid FTT following SARS-CoV-2 vaccination.
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49
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Fervers P, Kottlors J, Persigehl T, Lennartz S, Maus V, Fischer S, Styczen H, Deuschl C, Schlamann M, Mpotsaris A, Zubel S, Schroeter M, Maintz D, Fink GR, Abdullayev N. Meaningful use of imaging resources to rule out cerebral venous sinus thrombosis after ChAdOx1 COVID-19 vaccination: Evaluation of the AHA diagnostic algorithm with a clinical cohort and a systematic data review. J Clin Neurosci 2022; 102:5-12. [PMID: 35687921 PMCID: PMC9167954 DOI: 10.1016/j.jocn.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous thrombosis (CVST) is an improbable (0.0005%), however potentially lethal complication after ChAdOx1 vaccination. On the other hand, headache is among the most frequent side effects of ChAdOx1 (29.3%). In September 2021, the American Heart Association (AHA) suggested a diagnostic workflow to facilitate risk-adapted use of imaging resources for patients with neurological symptoms after ChAdOx1. We aimed to evaluate the AHA workflow in a retrospective patient cohort presenting at four primary care hospitals in Germany for neurological complaints after ChAdOx1. Scientific literature was screened for case reports of VITT with CVST after ChAdOx1, published until September 1st, 2021. One-hundred-thirteen consecutive patients (77 female, mean age 38.7 +/− 11.9 years) were evaluated at our institutes, including one case of VITT with CVST. Further 228 case reports of VITT with CVST are published in recent literature, which share thrombocytopenia (225/227 reported) and elevated d-dimer levels (100/101 reported). The AHA workflow would have recognized all VITT cases with CVST (100% sensitivity), the number needed to diagnose (NND) was 1:113. Initial evaluation of thrombocytopenia or elevated d-dimer levels would have lowered the NND to 1:68, without cost of sensitivity. Hence, we suggest that in case of normal thrombocyte and d-dimer levels, the access to further diagnostics should be limited by the established clinical considerations regardless of vaccination history.
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50
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Daly S, Nguyen AV, Soto JM, Vance AZ. Ad26.COV2.S Vaccine-Induced Thrombocytopenia Leading to Dural Sinus Thrombosis and Intracranial Hemorrhage Requiring Hemicraniectomy: A Case Report and Systematic Review. Cureus 2022; 14:e28083. [PMID: 36127984 PMCID: PMC9477649 DOI: 10.7759/cureus.28083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has claimed nearly 5.5 million lives worldwide. Adenovirus-based vaccines are safe and effective, but they are rarely associated with vaccine-induced thrombosis and thrombocytopenia (VITT) as well as cerebral venous sinus thrombosis (CVST). We conducted a systematic literature search of intracerebral hemorrhage (ICH) secondary to CVST associated with VITT from the Ad26.COV2.S vaccine, and we present the first case of this pathology in the reviewed literature of a patient who required neurosurgical decompression. The systematic literature review was completed on December 19, 2021, by searching PubMed and Ovid for articles with primary data on CVST associated with VITT following the Ad26.COV2.S vaccine. We also specifically searched for cases that required neurosurgical intervention. Articles were independently screened by two authors, and both secondary and tertiary searches were done as well. Descriptive statistics were collected and presented in table form. Nine studies were identified that met inclusion criteria. There were no cases identified of patients who underwent neurosurgical decompression after developing this pathology. We thus present the first case in the reviewed literature of a patient who developed ICH after receiving the Ad26.COV2.S vaccine and underwent decompressive hemicraniectomy. Despite severe thrombocytopenia and prolonged intensive care, the patient was discharged to neurorehabilitation. There is a much greater risk of CVST and ICH during COVID-19 infections than from the vaccines. However, as booster vaccines are approved and widely distributed, it is critical to make prompt, accurate diagnoses of this vaccine-related complication and consider neurosurgical decompression.
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Affiliation(s)
- Samuel Daly
- Neurological Surgery, Baylor Scott & White Medical Center-Temple, Temple, USA
| | - Anthony V Nguyen
- Neurological Surgery, Baylor Scott & White Medical Center-Temple, Temple, USA
| | - Jose M Soto
- Neurological Surgery, Baylor Scott & White Medical Center-Temple, Temple, USA
| | - Awais Z Vance
- Neurological Surgery, Baylor Scott & White Medical Center-Temple, Temple, USA
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