Cerebral Venous Sinus Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia in Middle-Income Countries.

van de Munckhof, Anita; Borhani-Haghighi, Afshin; Aaron, Sanjith; Krzywicka, Katarzyna; Sanchez van Kammen, Mayte; Cordonnier, Charlotte; Kleinig, Timothy; Field, Thalia Shoshana; Poli, Sven; Lemmens, Robin; Scutelnic, Adrian; Lindgren, Erik; Duan, Jiangang; Arslan, Yıldız; van Gorp, Eric C M; Hovinga, Johanna A Kremer; Guenther, Albrecht; Jood, Katarina; Tatlisumak, Turgut; Putaala, Jukka; ... (2023). Cerebral Venous Sinus Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia in Middle-Income Countries. International journal of stroke, 18(9), pp. 1112-1120. SAGE 10.1177/17474930231182901

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Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs.


We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs.


We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs).


Until August 2022, 228 CVST cases were reported, of which 63 from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these, 32/63 (51%) met the VITT criteria, compared to 103/165 (62%) from HICs. Only 5/32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-PF4 antibodies were often not tested. Median age was 26 (IQR 20-37) vs 47 (IQR 32-58) years, and proportion of women was 25/32 (78%) vs 77/103 (75%) in MICs vs HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95%CI 11-40]) than HICs (44/102 [43%, 95%CI 34-53], p=0.039).


The number of CVST-VITT cases reported from LMICs was small despite widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.

Item Type:

Journal Article (Original Article)


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

UniBE Contributor:

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


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

07 Jun 2023 12:39

Last Modified:

18 Dec 2023 11:04

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Uncontrolled Keywords:

COVID-19 Cerebral venous thrombosis Developing countries Global health Stroke subtypes TTS Thrombocytopenia VITT Vaccinations Vascular events



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