Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia.

Krzywicka, Katarzyna; Aguiar de Sousa, Diana; Cordonnier, Charlotte; Bode, Felix J; Field, Thalia S; Michalski, Dominik; Pelz, Johann; Skjelland, Mona; Wiedmann, Markus; Zimmermann, Julian; Wittstock, Matthias; Zanotti, Bruno; Ciccone, Alfonso; Bandettini di Poggio, Monica; Borhani-Haghighi, Afshin; Chatterton, Sophie; Aujayeb, Avinash; Devroye, Annemie; Dizonno, Vanessa; Geeraerts, Thomas; ... (2023). Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. European journal of neurology, 30(5), pp. 1335-1345. Wiley 10.1111/ene.15735

[img]
Preview
Text
Euro_J_of_Neurology_-_2023_-_Krzywicka_-_Decompressive_surgery_in_cerebral_venous_sinus_thrombosis_due_to_vaccine_induced.pdf - Accepted Version
Available under License Publisher holds Copyright.

Download (919kB) | Preview

BACKGROUND

Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after SARS-CoV-2 vaccination. CVST-VITT patients often present with large intracerebral hemorrhages and a high proportion undergoes decompressive surgery. We describe clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery, and explore predictors of in-hospital mortality in these patients.

METHODS

We used data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022. We included definite, probable and possible VITT cases, as defined by Pavord et al. RESULTS: Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p<0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found among patients with preoperative coma (17/18, 94% vs 4/14, 29% in the non-comatose; p<0.001), and bilaterally absent pupillary reflexes (7/7, 100%, vs 6/9, 67% with unilaterally reactive pupil, and 4/11, 36%, with bilateral reactive pupils; p=0.023). Postoperative imaging revealed worsening of index hemorrhagic lesion in 19 (70%) patients and new hemorrhagic lesions in 16 (59%) patients. At median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent.

CONCLUSIONS

Almost two thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Scutelnic, Adrian, Heldner, Mirjam Rachel, Arnold, Marcel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1468-1331

Publisher:

Wiley

Language:

English

Submitter:

Pubmed Import

Date Deposited:

13 Feb 2023 10:02

Last Modified:

13 Feb 2024 00:25

Publisher DOI:

10.1111/ene.15735

PubMed ID:

36773014

Uncontrolled Keywords:

COVID-19 vaccinations brain death cerebral venous thrombosis coma surgery

BORIS DOI:

10.48350/178677

URI:

https://boris.unibe.ch/id/eprint/178677

Actions (login required)

Edit item Edit item
Provide Feedback