Infectious Disease

Half of the patients with rare COVID-19 vaccine-induced thrombotic syndrome have CVST

October 11, 2021

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More than 50% of people with thrombosis and thrombocytopenia syndrome associated with the administration of COVID-19 vector-based vaccines had a cerebral sinus thrombosis, according to a study.

“There is a rapidly growing awareness of the urgency to better characterize the newly described ‘Thrombosis and Thrombocytopenia Syndrome’ (TTS) in connection with viral vector-based vaccines against SARS-CoV-2.” Lina Palaiodimou, MD, of the second department of neurology at Attikon University Hospital in Greece, and colleagues wrote in neurology.

Infographic data derived from: Palaiodimou L, et al. Neurology. 2021; doi: 10.1212 / WNL.0000000000012896.

“The latest safety signals from national and international pharmacovigilance authorities, as well as an increasing number of published reports of cerebral venous sinus thrombosis (CVST) and thrombosis in unusual places in combination with thrombocytopenia point to the association of TTS with the viral vector-based SARS-CoV-2 -Vaccines: ChAdOx1 nCoV-19 (Vaxzevria, AstraZeneca / Oxford) and Ad26.COV2.S (Janssen / Johnson & Johnson), ”they said

Reports have shown additional cases of CVST and thrombotic or thromboembolic events after COVID-19 vaccination that did not occur with thrombocytopenia. This raises “excellent concerns” about the factors that differentiate TTS and other thromboses temporarily associated with COVID-19 vaccination, according to the researchers.

Palaiodimou and colleagues performed a systematic review and meta-analysis to determine the proportion of CVST among TTS cases and to examine its characteristics and results. They included clinical studies, cohorts, case series and register-based studies. In particular, they attempted to calculate the pooled mortality rate from CVST, TTS-related CVST, and TTS, as well as the pooled proportion of patients with CVST among patients with a thrombotic event and TTS. The secondary endpoints were clinical characteristics of patients with a thrombotic event after vaccination.

In the qualitative analysis, researchers included 69 studies involving 370 patients with CVST and 4,182 patients with thrombotic events related to vector-based vaccine administration of COVID-19. They included 23 studies in the quantitative meta-analysis.

The results showed a pooled proportion of CVST of 51% (95% CI, 36-66) among TTS cases. Palaiodimou and colleagues found an independent association between TTS and an increased risk of CVST compared to non-TTS patients with thrombotic events after vaccination (OR = 13.8; 95% CI, 2-97.3). In addition, they reported pooled mortality rates of 28% (95% CI, 21-36) and 38% (95% CI, 27-49) for TTS and TTS-related CVST, respectively. Thrombotic complications occurred within 2 weeks of receiving the COVID-19 vaccine, mostly in women under 45 years of age, even when no prothrombotic risk factors were present.

“Since the risk-benefit assessments of the international regulatory authorities continue to emphasize the overwhelmingly favorable benefit-risk ratio for vaccination against SARS-CoV-2 in scenarios with high incidence rates, a sufficient characterization of the TTS is sufficient for a quick diagnosis and timely treatment of “Introduction that could improve the poor prognosis of TTS patients after vaccination based on adenovirus vectors,” wrote Palaiodimou and colleagues.

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