Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19.

Scutelnic, Adrian; van de Munckhof, Anita; Krzywicka, Katarzyna; van Kammen, Mayte Sánchez; Lindgren, Erik; Cordonnier, Charlotte; Kleinig, Timothy J; Field, Thalia S; Poli, Sven; Lemmens, Robin; Middeldorp, Saskia; Aaron, Sanjith; Borhani-Haghighi, Afshin; Arauz, Antonio; Kremer Hovinga, Johanna A; Günther, Albrecht; Putaala, Jukka; Wasay, Mohammad; Conforto, Adriana Bastos; de Sousa, Diana Aguiar; ... (2023). Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19. European stroke journal, 8(4), pp. 1001-1010. Sage 10.1177/23969873231185213

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INTRODUCTION

Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men.

PATIENTS AND METHODS

We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men.

RESULTS

Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ.

DISCUSSION AND CONCLUSIONS

Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.

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