Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Scutelnic, A; Krzywicka, K; Mbroh, J; van, de, Munckhof, A; van, Kammen, MS; de, Sousa, DA; Lindgren, E; Jood, K; Günther, A; Hiltunen, S; Putaala, J; Tiede, A; Maier, F; Kern, R; Bartsch, T; Althaus, K; Ciccone, A; Wiedmann, M; Skjelland, M; Medina, A; Cuadrado-Godia, E; Cox, T; Aujayeb, A; Raposo, N; Garambois, K; Payen, JF; Vuillier, F; Franchineau, G; Timsit, S; Bougon, D; Dubois, MC; Tawa, A; Tracol, C; De, Maistre, E; Bonneville, F; Vayne, C; Mengel, A; Michalski, D; Pelz, J; Wittstock, M; Bode, F; Zimmermann, J; Schouten, J; Buture, A; Murphy, S; Palma, V; Negro, A; Gutschalk, A; Nagel, S; Schoenenberger, S; Frisullo, G; Zanferrari, C; Grillo, F; Giammello, F; Martin, MM; Cervera, A; Burrow, J; Esperon, CG; Chew, BLA; Kleinig, TJ; Soriano, C; Zimatore, DS; Petruzzellis, M; Elkady, A; Miranda, MS; Fernandes, J; Vogel, ÅH; Johansson, E; Philip, AP; Coutts, SB; Bal, S; Buck, B; Legault, C; Blacquiere, D; Katzberg, HD; Field, TS; Dizonno, V; Gattringer, T; Jacobi, C; Devroye, A; Lemmens, R; Kristoffersen, ES; di, Poggio, MB; Ghiasian, M; Karapanayiotides, T; Chatterton, S; Wronski, M; Ng, K; Kahnis, R; Geeraerts, T; Reiner, P; Cordonnier, C; Middeldorp, S; Levi, M; van, Gorp, ECM; van, de, Beek, D; Brodard, J; Kremer, Hovinga, JA; Kruip, MJHA; Tatlisumak, T; Ferro, JM; Coutinho, JM; Arnold, M; Poli, S; Heldner, MR.
Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination.
Ann Neurol. 2022; 92(4): 562-573.
Doi: 10.1002/ana.26431
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- Co-Autor*innen der Med Uni Graz
- Gattringer Thomas
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- Abstract:
- OBJECTIVE: Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. METHODS: We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. RESULTS: Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16-1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06-0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24-2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74-6.54). CONCLUSIONS: In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. ANN NEUROL 2022;92:562-573.
- Find related publications in this database (using NLM MeSH Indexing)
- Adenoviridae - administration & dosage
- Anticoagulants - therapeutic use
- COVID-19 - administration & dosage
- COVID-19 Vaccines - adverse effects
- Humans - administration & dosage
- Immunoglobulins, Intravenous - therapeutic use
- Intracranial Thrombosis - administration & dosage
- SARS-CoV-2 - administration & dosage
- Vaccination - adverse effects
- Venous Thrombosis - complications