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