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      Comparative Study of Cerebral Venous Thrombosis-Risk Factors, Clinical Course, and Outcome in Subjects with and without COVID-19 Infection

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          Abstract

          Background/Objective

          Cerebral venous thrombosis (CVT) has been increasingly reported in patients with COVID-19. Most published literature is descriptive and focuses only on CVT in COVID-19 patients. The objective of our study was to compare CVT patients’ characteristics with and without an associated COVID-19 infection.

          Materials and Methods

          This is a retrospective cross-sectional study. All adult patients with a confirmed diagnosis of CVT admitted to our hospital over a period of 30 months, from January 2019 to June 2021, were included. They were further divided into two groups, with and without COVID-19 infection.

          Results

          A total of 115 CVT patients were included, 93 in non-COVID-CVT and 22 in COVID-CVT group. COVID-CVT patients were male predominant and of older age, with longer hospital stay, and higher inpatient mortality. COVID-CVT patients presented with a higher frequency of headache (82% vs. 63%), seizures (64% vs. 37%, p = 0.03), hemiparesis (41% vs. 24%), and visual changes (36% vs. 19%) as compared to non-COVID-CVT patients. Venogram showed a higher frequency of superior sagittal sinus (64% vs. 42%) and internal jugular vein (23% vs. 12%) involvement in the COVID-CVT cohort. More than 90% of patients in both groups received therapeutic anticoagulation. Mortality rates were higher in COVID-CVT group (18% vs. 11%).

          Conclusion

          COVID-CVT patients were male predominant and of older age, with higher hospital stay, and higher inpatient mortality as compared to non-COVID-CVT patients.

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          Incidence of thrombotic complications in critically ill ICU patients with COVID-19

          F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer … (2020)
          Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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            Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination

            Andreas Greinacher, Thomas Thiele, Theodore Warkentin … (2021)
            Background Several cases of unusual thrombotic events and thrombocytopenia have developed after vaccination with the recombinant adenoviral vector encoding the spike protein antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (ChAdOx1 nCov-19, AstraZeneca). More data were needed on the pathogenesis of this unusual clotting disorder. Methods We assessed the clinical and laboratory features of 11 patients in Germany and Austria in whom thrombosis or thrombocytopenia had developed after vaccination with ChAdOx1 nCov-19. We used a standard enzyme-linked immunosorbent assay to detect platelet factor 4 (PF4)–heparin antibodies and a modified (PF4-enhanced) platelet-activation test to detect platelet-activating antibodies under various reaction conditions. Included in this testing were samples from patients who had blood samples referred for investigation of vaccine-associated thrombotic events, with 28 testing positive on a screening PF4–heparin immunoassay. Results Of the 11 original patients, 9 were women, with a median age of 36 years (range, 22 to 49). Beginning 5 to 16 days after vaccination, the patients presented with one or more thrombotic events, with the exception of 1 patient, who presented with fatal intracranial hemorrhage. Of the patients with one or more thrombotic events, 9 had cerebral venous thrombosis, 3 had splanchnic-vein thrombosis, 3 had pulmonary embolism, and 4 had other thromboses; of these patients, 6 died. Five patients had disseminated intravascular coagulation. None of the patients had received heparin before symptom onset. All 28 patients who tested positive for antibodies against PF4–heparin tested positive on the platelet-activation assay in the presence of PF4 independent of heparin. Platelet activation was inhibited by high levels of heparin, Fc receptor–blocking monoclonal antibody, and immune globulin (10 mg per milliliter). Additional studies with PF4 or PF4–heparin affinity purified antibodies in 2 patients confirmed PF4-dependent platelet activation. Conclusions Vaccination with ChAdOx1 nCov-19 can result in the rare development of immune thrombotic thrombocytopenia mediated by platelet-activating antibodies against PF4, which clinically mimics autoimmune heparin-induced thrombocytopenia. (Funded by the German Research Foundation.)
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              Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence

              Julien Poissy, Julien Goutay, Morgan Caplan … (2020)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cerebrovasc Dis Extra
                Journal ID (iso-abbrev): Cerebrovasc Dis Extra
                Journal ID (hwp): CEE
                Journal ID (publisher-id): CEE
                Title: Cerebrovascular Diseases Extra
                Publisher: S. Karger AG (Basel, Switzerland )
                ISSN (Electronic): 1664-5456
                Publication date Collection: Jan-Dec 2023
                Publication date (Electronic): 25 April 2023
                Volume: 13
                Issue: 1
                Pages: 63-68
                Affiliations
                [a ]Department of Neurology, University of Virginia, Charlottesville, VA, USA
                [b ]Department of Neurology, Aga Khan University, Karachi, Pakistan
                [c ]Liaquat College of Medicine and Dentistry, Karachi, Pakistan
                [d ]Rashid Hospital, Dubai, UAE
                [e ]B.L.Kapur Hospital (Max Health Care Group), Centre for Neurosciences, New Delhi, India
                Author notes
                Correspondence to: Mohammad Wasay, mohammad.wasay@ 123456aku.edu
                Article
                Publisher ID: 530819
                DOI: 10.1159/000530819
                PMC ID: 10314989
                PubMed ID: 37166317
                SO-VID: b951afc6-ec5d-48da-a345-8e8c83ce79c9
                Copyright © © 2023 The Author(s). Published by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 1 March 2023
                Date accepted : 18 April 2023
                Date: 2023
                Page count
                Tables: 2, References: 23, Pages: 6
                Funding
                Authors did not receive any funding for this project.
                Categories
                Subject: Stroke Spectrum

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cerebral venous thrombosis,coronavirus disease 2019,risk factors,demographics,outcome
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cerebral venous thrombosis, coronavirus disease 2019, risk factors, demographics, outcome

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