Cerebral venous sinus thrombosis in the setting of COVID-19 vaccination: a systematic review and meta-analysis

• Published in: Journal of neurology 2022-07, Vol.269 (7), p.3413-3419
• Main Authors: Palaiodimou, Lina, Stefanou, Maria-Ioanna, de Sousa, Diana Aguiar, Coutinho, Jonathan M., Papadopoulou, Marianna, Papaevangelou, Vasiliki, Vassilakopoulos, Theodoros I., Tsiodras, Sotirios, Filippou, Dimitrios K., Tsivgoulis, Georgios
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; COVID-19 vaccines; Epidemiology; Hemorrhage; Immunization; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Neurology; Neuroradiology; Neurosciences; Original Communication; Patients; Phenotypes; Risk factors; Systematic review; Thrombocytopenia; Thrombosis; Vaccines
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-022-11101-2

Background and Purpose Cerebral venous sinus thrombosis (CVST) has been reported as a rare adverse event in association with thrombosis-thrombocytopenia syndrome (TTS) following COVID-19 vaccination. Methods  We performed a systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases, with the aim to calculate (1) the odds ratio of TTS–CVST versus non-TTS–CVST after vector-based vaccines and (2) after non-vector-based vaccines, (3) the in-hospital mortality ratio of TTS–CVST compared to non-TTS–CVST; and (4) the dependency or death at discharge among TTS–CVST compared to non-TTS–CVST cases. Results Two eligible studies were included in the meta-analysis, comprising a total of 211 patients with CVST associated with COVID-19 vaccination. Vector-based COVID-19 vaccination was associated with a higher likelihood of TTS-associated CVST than with non-TTS–CVST (OR: 52.34, 95% CI 9.58–285.98). TTS–CVST was also associated with higher likelihood of in-hospital mortality (OR: 13.29; 95% CI 3.96–44.60) and death or dependency at discharge compared to non-TTS–CVST (OR: 6.70; 95% CI 3.15–14.26). TTS–CVST was recorded with a shorter interval between vaccination and symptom onset [Mean Difference (MD):-6.54 days; 95% CI − 12.64 to − 0.45], affecting younger patients (MD:-9.00 years; 95% CI − 14.02 to − 3.99) without risk factors for thromboses (OR:2.34; 95% CI 1.26–4.33), and was complicated more frequently with intracerebral hemorrhage (OR:3.60; 95% CI 1.31–9.87) and concomitant thromboses in other sites (OR:11.85; 95% CI 3.51–39.98) compared to non-TTS–CVST cases. Conclusions TTS–CVST following COVID-19 vaccination has distinct risk factor profile, clinical phenotype and prognosis compared to non-TTS–CVST. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS–CVST cases following COVID-19 vaccination.