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Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review.
Aguiar de Sousa, Diana; Romoli, Michele; Sánchez Van Kammen, Mayte; Heldner, Mirjam R; Zini, Andrea; Coutinho, Jonathan M; Arnold, Marcel; Ferro, José M.
  • Aguiar de Sousa D; Department of Neurology, Centro Hospitalar Universitário de Lisboa Norte - Hospital de Santa Maria, Lisbon, Portugal (D.A.d.S., J.M.F.).
  • Romoli M; Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.).
  • Sánchez Van Kammen M; Neurology and Stroke Unit, "Maurizio Bufalini" Hospital, Cesena, Italy (M.R.).
  • Heldner MR; Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Italy (M.R.).
  • Zini A; Department of Neurology, Amsterdam University Medical Center, the Netherlands (M.S.V.K., J.M.C.).
  • Coutinho JM; Department of Neurology, University hospital and University of Bern, Switzerland (M.R.H., M.A.).
  • Arnold M; IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy (A.Z.).
  • Ferro JM; Department of Neurology, Amsterdam University Medical Center, the Netherlands (M.S.V.K., J.M.C.).
Stroke ; 53(6): 1892-1903, 2022 06.
Article in English | MEDLINE | ID: covidwho-1731382
ABSTRACT

BACKGROUND:

Cerebral venous thrombosis (CVT) has recently been reported as a common thrombotic manifestation in association with vaccine-induced thrombotic thrombocytopenia, a syndrome that mimics heparin-induced thrombocytopenia (HIT) and occurs after vaccination with adenovirus-based SARS-CoV-2 vaccines. We aimed to systematically review the incidence, clinical features, and prognosis of CVT occurring in patients with HIT.

METHODS:

The study protocol was registered with PROSPERO (CRD42021249652). MEDLINE, EMBASE and Cochrane CENTRAL were searched up to June 1, 2021 for HIT case series including >20 patients, or any report of HIT-related CVT. Demographic, neuroradiological, clinical, and mortality data were retrieved. Meta-analysis of proportions with random-effect modeling was used to derive rate of CVT in HIT and in-hospital mortality. Pooled estimates were compared with those for CVT without HIT and HIT without CVT, to determine differences in mortality.

RESULTS:

From 19073 results, we selected 23 case series of HIT (n=1220) and 27 cases of HIT-related CVT (n=27, 71% female). CVT developed in 1.6% of 1220 patients with HIT (95% CI,1.0%-2.5%, I2=0%). Hemorrhagic brain lesions occurred in 81.8% of cases of HIT-related CVT and other concomitant thrombosis affecting other vascular territory was reported in 47.8% of cases. In-hospital mortality was 33.3%. HIT-related CVT carried a 29% absolute increase in mortality rate compared with historical CVT controls (33.3% versus 4.3%, P<0.001) and a 17.4% excess mortality compared with HIT without CVT (33.3% versus 15.9%, P=0.046).

CONCLUSIONS:

CVT is a rare thrombotic manifestation in patients with HIT. HIT-related CVT has higher rates of intracerebral hemorrhage and a higher mortality risk, when compared with CVT in historical controls. The recently reported high frequency of CVT in patients with vaccine-induced thrombotic thrombocytopenia was not observed in HIT, suggesting that additional pathophysiological mechanisms besides anti-platelet factor-4 antibodies might be involved in vaccine-induced thrombotic thrombocytopenia-related CVT.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Vaccines / Venous Thrombosis / Intracranial Thrombosis / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid / Vaccines Limits: Female / Humans / Male Language: English Journal: Stroke Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Thrombosis / Vaccines / Venous Thrombosis / Intracranial Thrombosis / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid / Vaccines Limits: Female / Humans / Male Language: English Journal: Stroke Year: 2022 Document Type: Article