ABSTRACT
Background and aims: Cerebral venous sinus thrombosis (CVST) has been acknowledged as a rare adverse event related to thrombosisthrombocytopenia syndrome (TTS) following COVID-19 vaccination. Methods: A systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases was performed, with the aim to calculate the odds ratio of TTS-CVST versus non-TTS-CVST (1) after vector-based vaccines and (2) after non-vector-based vaccines;(3) the inhospital 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 - -0.45], affecting younger patients (MD:-9.00 years;95%CI: -14.02 - -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-CVT following COVID-19 has distinct clinical phenotype and prognosis compared to non-TTS-CVT. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS-CVT cases following COVID-19 vaccination.
ABSTRACT
Background and aims: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation (AC) dose in COVID-19. Methods: We conducted a living systematic review and meta-analysis on the effects of different low molecular weight heparin (LMWH) and/ or fondaparinux doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients. MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH or fondaparinux among confirmed COVID-19 cases. Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between AC and mortality during the following comparisons: a) no AC versus any AC;b) prophylactic versus higher than prophylactic AC;c) prophylactic versus therapeutic AC;d) intermediate versus therapeutic AC;and e) lower than therapeutic versus therapeutic AC. However, the risk for all-cause mortality was higher in patients receiving prophylactic versus intermediate AC (OR=2.01;95%CI: 1.19-3.39). No associations were detected between the intensity of AC and the risk of thrombotic and hemorrhagic events, except the significantly lower risk for hemorrhage in patients on prophylactic compared to higher AC doses. Conclusions: The risk for all-cause mortality was significantly higher in patients receiving prophylactic AC compared to those on an intermediate dose of AC. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies.
ABSTRACT
Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.
ABSTRACT
Background: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducted a systematic review and meta-analysis to evaluate the aforementioned considerations. Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARSCoV- 2 infection status. We used a random-effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI). Results: We identified 16 cohort studies including 44,004 patients. Among patients with SARS-CoV- 2, 1.3% (95%CI: 0.9-1.8%;I =88%) were hospitalized for cerebrovascular events, 1.2% (95%CI: 0.8-1.5%;I =85%) for ischemic stroke, and 0.2% (95%CI: 0.1-0.4%;I =69%) for hemorrhagic stroke. Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3.58, 95%CI: 1.43-8.92;I =43%) and cryptogenic stroke (OR=3.98, 95%CI: 1.62-9.77;I =0%). Odds for in-hospital mortality were higher among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical stroke patients (OR=5.60, 95%CI: 3.19-9.80;I =45%). SARS-CoV-2 infection status was not associated to the likelihood of receiving intravenous thrombolysis (OR=1.42, 95%CI: 0.65-3.10;I =0%) or endovascular thrombectomy (OR=0.78, 95%CI: 0.35-1.74;I =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls(OR=1.39, 95%CI: 1.04-1.86;I =0%). Conclusion: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke,particularly the cryptogenic subtype. SARS-CoV-2 infection in stroke substantially increases themortality risk.