Cerebral Venous Sinus Thrombosis following COVID-19 Vaccination: Analysis of 552 Worldwide Cases
Cesare de Gregorio,
Luigi Colarusso,
Giuseppe Calcaterra,
Pier Paolo Bassareo,
Antonio Ieni,
Anna Teresa Mazzeo,
Giuseppe Ferrazzo,
Alberto Noto,
Ioanna Koniari,
Jawahar L. Mehta,
Nicholas G. Kounis
Affiliations
Cesare de Gregorio
Department of Clinical and Experimental Medicine, Division of Cardiology, G. Martino University Hospital Medical School of Messina, 98125 Messina, Italy
Luigi Colarusso
Department of Clinical and Experimental Medicine, Division of Cardiology, G. Martino University Hospital Medical School of Messina, 98125 Messina, Italy
Giuseppe Calcaterra
Department of Cardiology, Postgraduate Medical School of Cardiology, University of Palermo, 90127 Palermo, Italy
Pier Paolo Bassareo
Department of Cardiology, Mater Misericordiae University Hospital Crumlin, University College of Dublin, D07R2WY Dublin, Ireland
Antonio Ieni
Pathology Unit, Department of Human Pathology G. Barresi, G. Martino University Hospital Medical School of Messina, 98125 Messina, Italy
Anna Teresa Mazzeo
Department of Human Pathology G. Barresi, Division of Anesthesia and Critical Care, G. Martino University Hospital Medical School of Messina, 98125 Messina, Italy
Giuseppe Ferrazzo
Department of Clinical and Experimental Medicine, Division of Cardiology, G. Martino University Hospital Medical School of Messina, 98125 Messina, Italy
Alberto Noto
Department of Human Pathology G. Barresi, Division of Anesthesia and Critical Care, G. Martino University Hospital Medical School of Messina, 98125 Messina, Italy
Ioanna Koniari
Department of Cardiology, University Hospital of South Manchester, NHS Foundation Trust, Manchester M23 9LT, UK
Jawahar L. Mehta
Department of Medicine, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA
Nicholas G. Kounis
Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26221 Patras, Greece
To date, billions of vaccine doses have been administered to restrain the current COVID-19 pandemic worldwide. Rare side effects, including intravascular blood clots, were reported in the general population after vaccination. Among these, cerebral venous sinus thrombosis (CVST) has been considered the most serious one. To shed further light on such an event, we conducted a literature search for case descriptions of CVST in vaccinated people. Findings were analyzed with emphasis on demographic characteristics, type of vaccine, site of thrombosis, clinical and histopathological findings. From 258 potential articles published till September 2021, 41 studies were retrieved for a total of 552 patients. Of these, 492 patients (89.1%) had received AZD1222/Vaxzevria, 45 (8.2%) BNT162b2/CX-024414 Spikevax, 15 (2.7%) JNJ-78436735, and 2 (0.3%) Covishield vaccine. CVST occurred in 382 women and 170 men (mean aged 44 years), and the median timing from the shot was 9 days (range 2–45). Thrombi were predominantly seen in transverse (84%), sigmoid (66%), and/or superior sagittal (56%) sinuses. Brain injury (chiefly intracranial bleeding) occurred in 32% of cases. Of 426 patients with detailed clinical course, 63% were discharged in good clinical conditions, at times with variable neurological sequelae, whereas 37% deceased, largely due to brain injury. This narrative review confirmed CVST as a rare event after (adenoviral vector) COVID-19 vaccination, with a women/men rate ratio of 2.25. Though the pathogenesis of thrombosis is still under discussion, currently available histopathological findings likely indicate an underlying immune vasculitis.