ABSTRACT
Background and aims: Since initiation of COVID-19 vaccination, cases of cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) have been reported. Reported in-hospital mortality varies between 20-50%, but data on longterm outcome of surviving patients with CVT-VITT are not available. Methods: We report follow-up data of CVT-VITT cases after COVID- 19 vaccination from an international registry. VITT was classified according to the Pavord criteria. Outcomes were mortality, functional dependency, relapse of VITT, new thrombosis, and new bleeding events. Results: Of 62 patients with CVT-VITT who survived initial hospital admission, follow-up data were available for 48/62 (77%) cases (32 (67%) definite VITT, 7 (15%) probable VITT, 9 (19%) possible VITT). Median time from diagnosis to last follow-up was 110 days (IQR 86-174). There were no new venous or arterial thrombotic events reported in any case. Among 35/44 (80%) cases that achieved clinical remission, 0/29 cases had a relapse of VITT. Major bleeding was reported in 1/45 (2%) cases (intracranial bleed). Mortality at follow-up was 1/48 (2%, 95%CI 0-11%). 44/48 (92%) cases had a modified Rankin Scale score of 0-2 at follow-up, compared to 32/46 (70%) at hospital discharge. 16/34 (47%) of cases had returned to work or school. Conclusions: In patients who survive the acute phase of CVT-VITT, long-term mortality is low and thrombotic and bleeding events are rare. Approximately half of the CVT-VITT patients at follow-up could resume all daily activities.
ABSTRACT
Background and aims: Cerebral venous sinus thrombosis with thrombocytopenia syndrome (CVST-TTS) is a rare adverse effect of adenovirus- based SARS-CoV-2 vaccines. After the autoimmune pathogenesis of TTS was discovered, treatment recommendations were issued. The aim of this study was to evaluate if adherence to treatment recommendations was associated with lower mortality. Methods: TTS was defined according to the Brighton criteria. Cases from a prospective international CVT registry with symptom onset within 28 days of adenovirus-based SARS-CoV-2 vaccination were analysed. Treatment recommendations, following the International Society of Thrombosis and Haemostasis, included use of immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusions, unless needed for surgery. Results: Out of 178 CVT cases from 117 centres in 19 countries reported between March 29 and September 3, 2021, 95 patients fulfilled inclusion criteria. Five of 37 (14%), 13/25 (52%), and 29/33 (88%) of patients diagnosed in March, April, and from May onwards, respectively, were treated according to recommendations. Proportion of patients diagnosed in March, April, and from May onwards who received immunomodulation increased from 19/37 (51%) over 15/25 (60%) to 30/33 (90%), and the percentage of patients who were treated with heparins [26/37 (70%), 4/25 (16%), 1/33 (3%)] and platelet transfusion [15/37 (41%), 4/25 (16%), 7/33 (21%), respectively] decreased accordingly. Mortality of patients treated according to recommendations was 14/47 (30%, 95%CI 19-44%) compared to 28/48 (58%, 95%CI 44-71%) in patients not treated according to recommendations (OR 3.30, 95%CI 1.41-7.71). Conclusions: Over time, adherence to treatment recommendations improved, and mortality rate of patients with CVST-TTS decreased.
ABSTRACT
Background and aims: Cerebral venous sinus thrombosis with thrombosis with thrombocytopenia syndrome (CVST-TTS) is a serious adverse drug reaction after adenoviral SARS-CoV-2 vaccinations. CVST-TTS patients may need decompressive surgery to avoid fatal brain herniation, but despite this intervention, many CVST-TTS patients die during the initial hospital admission. Here, we describe the characteristics and outcomes of CVST-TTS patients who underwent decompressive surgery and explore predictors of mortality in CVST-TTS patients. Methods: We used data from an ongoing international registry collecting data from patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March and 9 December 2021. TTS was defined in accordance with the Brighton Collaboration case definition. Results: Out of 97 CVST-TTS patients, 29 (30%) underwent decompressive surgery. All operated patients had an intracerebral haemorrhage before the surgery. In-hospital mortality was 19/29 (66%) in the operated and 23/68 (34%) in the non-operated group. In the operated group, the highest mortality rate was among patients who were in coma before the surgery (14/15, 93% vs 4/12, 33% in those not in coma), had bilateral absence of the pupillary response (7/7, 100% vs 8/16, 50% in patients with uni/bilateral pupillary response) and platelet count <50 x103/μL (11/14, 79% vs 6/12, 50% in cases with a platelet count ≥50 x103/μL). Conclusion: Mortality rate of CVST-TTS patients who underwent decompressive surgery is extremely high. Among the operated patients, coma before the surgery, bilateral absence of the pupillary response, and platelet count <50 x103/μL were the predictors of mortality.
ABSTRACT
Purpose: Massachusetts has been heavily impacted by the COVID-19 pandemic with new cases rising from 6,621in March to 55,584 in April and 34,760 in May 2020. Most clinics and hospitals stopped performing electiveprocedures and reduced the volume of patients seeking in-person care starting in mid-March. This abstractquantifies the rates of mammography and PSA testing, both for screening and diagnostic purposes, as well asbreast and prostate biopsies performed during the first five months of 2020 as compared to the same months in2019 for a large health care provider group in central Massachusetts. Methods: Men and women aged 30-85 without a history of breast or prostate cancer who were active patients ofthe provider group between January 2019 and May 2020 were included in this analysis. We compared the monthlyrates per 1,000 people of mammography, total PSA, and breast and prostate biopsy for the period of January-May2019 and January-May 2020 overall and by age and race/ethnicity. Procedures were identified by CPT codes in thegroup's electronic health record. Results: In total, 65,312 men and 80,629 women were included in the analysis of 2019 data and 66,396 men and82,695 women in 2020. About 70% of the population was non-Hispanic white, 3% non-Hispanic Black, 4% Hispanic,4% Asian, and 18% other/unknown. The median age was 53 for men and 52 for women. The monthly number ofmammograms declined significantly between January-May 2019 and the same months in 2020 from an average of13.6 mammograms per 1,000 women per month in 2019 to 6.1 in March, 0.25 in April and 1.1 per 1,000 women inMay 2020. Digital tomosynthesis also declined from an average of 34.7 per 1,000 women in 2019 to 14.6, 1.4, and1.5 across March through May of 2020. The level of decline increased with age and was greatest among the oldestwomen, aged 75-85. Parallel declines occurred among all racial/ethnic groups. Breast biopsies declined steadilyfrom an average of 0.9 per 1,000 women per month in 2019 to 0.8 in March, 0.4 in April and 0.1 per 1,000 women inMay 2020. PSA testing was conducted in 2019 with an average of 34.4 men tested per 1,000 per month. Declines inPSA were slightly less than mammography with 17.6 tests completed per 1,000 men in March, 6.1 in April, and 11.3in May 2020. Prostate biopsies were infrequent in 2019 with an average of 0.15 per 1,000 men per month and didnot decline in 2020. Declines were slightly greater in younger men aged 30-54 and similar across racial/ethnicgroups. The greatest single-month change in test rates occurred between April 2019 and April 2020 in both women(screening mammogram rate declined 98%, tomosynthesis 96%) and men (PSA testing rate declined 83%), reflecting the peak of the COVID-19 surge in Massachusetts. Conclusions: The observed decline in these common screening and diagnostic procedures reflects the impact ofthe COVID-19 pandemic on cancer prevention and early detection, signaling possible downstream effects on thetiming and staging of future cancer diagnoses.