Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review.

Aguiar de Sousa, Diana; Romoli, Michele; Sánchez Van Kammen, Mayte; Heldner, Mirjam Rachel; Zini, Andrea; Coutinho, Jonathan M; Arnold, Marcel; Ferro, José M (2022). Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review. Stroke, 53(6), pp. 1892-1903. American Heart Association 10.1161/STROKEAHA.121.036824

Full text not available from this repository.

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.

Item Type:	Journal Article (Review Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
UniBE Contributor:	Heldner, Mirjam Rachel, Arnold, Marcel
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1524-4628
Publisher:	American Heart Association
Language:	English
Submitter:	Pubmed Import
Date Deposited:	07 Mar 2022 08:48
Last Modified:	05 Dec 2022 16:12
Publisher DOI:	10.1161/STROKEAHA.121.036824
PubMed ID:	35240862
Uncontrolled Keywords:	COVID-19 vaccines heparin hospital mortality platelet factor 4 prevalence sinus thrombosis, intracranial thrombosis
URI:	https://boris.unibe.ch/id/eprint/166598