Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal.
JAMA Neurol. 2021 Nov 1;78(11):1314-1323. doi: 10.1001/jamaneurol.2021.3619.
Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson).
To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination.
Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria.
Clinical characteristics and mortality rate.
Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later.
In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
在接种了 SARS-CoV-2 疫苗 ChAdOx1 nCov-19（牛津-阿斯利康）和 Ad26.COV2.S（杨森/强生）后，有报道称出现了伴有血小板减少的血栓形成伴血小板减少综合征（TTS）。
描述 COVID-19 疫苗接种后伴有和不伴有 TTS 的患者发生脑静脉窦血栓形成（CVST）的临床特征和结局。
设计、地点和参与者：本队列研究使用了 2021 年 3 月 29 日至 6 月 18 日期间，来自 81 家医院的 19 个国家的国际连续 CVST 患者登记处的数据，这些患者在接种 SARS-CoV-2 疫苗后 28 天内发生了 CVST。作为参考，2015 年至 2018 年期间发生 CVST 的患者数据来自一个现有的国际登记处。描述了（1）SARS-CoV-2 疫苗引起的免疫性血栓性血小板减少性血栓形成后 CVST，（2）接种 SARS-CoV-2 疫苗后不满足 TTS 标准的 CVST，（3）与 SARS-CoV-2 疫苗无关的 CVST 的成年患者的临床特征和死亡率。
如果患者出现新发性血小板减少症，且无近期肝素暴露，根据布赖顿合作组织的临时标准，将其归类为 TTS。
临床特征和死亡率。
在 116 例接种疫苗后发生 CVST 的患者中，78 例（67.2%）有 TTS，其中 76 例接种了 ChAdOx1 nCov-19；38 例（32.8%）无 TTS 指征。对照组包括 COVID-19 大流行前发生 CVST 的 207 例患者。分别有 63/78（81%）、30/38（79%）和 145/207（70.0%）的患者为女性，平均（SD）年龄分别为 45（14）、55（20）和 42（16）岁。在 TTS 组的 70 例患者中，25 例（36%）发生了同时发生的血栓栓塞，35 例患者中（6%）发生了非 TTS 组，206 例患者中（4.9%）发生了对照组，住院死亡率分别为 47%（36/76；95%CI，37-58）、5%（2/37；95%CI，1-18）和 3.9%（8/207；95%CI，2.0-7.4）。TTS 组中在科学界引起关注之前诊断出的 23 例患者中有 61%（14 例）死亡，而在科学界引起关注之后诊断出的 53 例患者中有 42%（22 例）死亡。
在这项对 CVST 患者的队列研究中，在接种 SARS-CoV-2 疫苗后符合 TTS 标准的患者中观察到了明显的临床特征和高死亡率。
