Journal of Stroke (May 2022)

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

  • Thanh N. Nguyen,
  • Muhammad M. Qureshi,
  • Piers Klein,
  • Hiroshi Yamagami,
  • Mohamad Abdalkader,
  • Robert Mikulik,
  • Anvitha Sathya,
  • Ossama Yassin Mansour,
  • Anna Czlonkowska,
  • Hannah Lo,
  • Thalia S. Field,
  • Andreas Charidimou,
  • Soma Banerjee,
  • Shadi Yaghi,
  • James E. Siegler,
  • Petra Sedova,
  • Joseph Kwan,
  • Diana Aguiar de Sousa,
  • Jelle Demeestere,
  • Violiza Inoa,
  • Setareh Salehi Omran,
  • Liqun Zhang,
  • Patrik Michel,
  • Davide Strambo,
  • João Pedro Marto,
  • Raul G. Nogueira,

DOI
https://doi.org/10.5853/jos.2022.00752
Journal volume & issue
Vol. 24, no. 2
pp. 256 – 265

Abstract

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Background and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

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