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Acute Arterial Ischemic Stroke Following COVID-19 Vaccination: A Systematic Review and Meta-analysis.
Stefanou, Maria-Ioanna; Palaiodimou, Lina; Aguiar de Sousa, Diana; Theodorou, Aikaterini; Bakola, Eleni; Katsaros, Dimitrios Eleftherios; Halvatsiotis, Panagiotis; Tzavellas, Elias; Naska, Androniki; Coutinho, Jonathan M; Sandset, Else Charlotte; Giamarellos-Bourboulis, Evangelos J; Tsivgoulis, Georgios.
  • Stefanou MI; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Palaiodimou L; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Aguiar de Sousa D; Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
  • Theodorou A; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Bakola E; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Katsaros DE; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Halvatsiotis P; Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece.
  • Tzavellas E; First Department of Psychiatry, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Naska A; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
  • Coutinho JM; Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Sandset EC; Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway.
  • Giamarellos-Bourboulis EJ; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece.
  • Tsivgoulis G; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece tsivgoulisgiorg@yahoo.gr.
Neurology ; 2022 Aug 24.
Article in English | MEDLINE | ID: covidwho-2065058
ABSTRACT

BACKGROUND:

Acute arterial-ischemic-stroke (AIS) has been reported as a rare adverse-event following COVID-19-vaccination with mRNA or viral-vector vaccines. However, data are sparse regarding the risk of post-vaccination AIS and its potential association with thrombotic-thrombocytopenia-syndrome (TTS).

METHODS:

A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs), pharmacovigilance registries, registry-based studies, observational cohorts and case-series was performed with the aim to calculate (1) the pooled proportion of patients presenting with AIS following COVID-19-vaccination; (2) the prevalence of AIS after mRNA and vector-based vaccination; (3) the proportion of TTS among post-vaccination AIS-cases. Patient characteristics were assessed as secondary outcomes.

RESULTS:

Two RCTs, three cohort and eleven registry-based studies comprising 17,481 AIS-cases among 782,989,363 COVID-19-vaccinations were included in the meta-analysis. The pooled proportion of AIS following exposure to any COVID-19-vaccine type was 4.7 cases per 100,000 vaccinations (95%CI2.2-8.1; I2=99.9%). The pooled proportion of AIS following mRNA-vaccination (9.2 cases per 100,000 vaccinations; 95%CI 2.5-19.3; I2=99.9%) did not differ compared to adenovirus-based-vaccination (2.9 cases per 100,000 vaccinations; 95%CI 0.3-7.8; I2=99.9%). No differences regarding demographics were disclosed between patients with AIS following mRNA- or vector-based vaccination. The pooled proportion of TTS among post-vaccination AIS-cases was 3.1% (95%CI 0.7-7.2%; I2=78.8%).

CONCLUSIONS:

The pooled proportion of AIS following COVID-19 vaccination is comparable to the prevalence of AIS in the general population and much lower than the AIS prevalence among SARS-CoV-2-infected patients. TTS is very uncommonly reported in patients with AIS following COVID-19 vaccination.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines Language: English Year: 2022 Document Type: Article Affiliation country: WNL.0000000000200996

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines Language: English Year: 2022 Document Type: Article Affiliation country: WNL.0000000000200996