Krzywicka Katarzyna, Aguiar de Sousa Diana, Cordonnier Charlotte, Bode Felix J, Field Thalia S, Michalski Dominik, Pelz Johann, Skjelland Mona, Wiedmann Markus, Zimmermann Julian, Wittstock Matthias, Zanotti Bruno, Ciccone Alfonso, Bandettini di Poggio Monica, Borhani-Haghighi Afshin, Chatterton Sophie, Aujayeb Avinash, Devroye Annemie, Dizonno Vanessa, Geeraerts Thomas, Giammello Fabrizio, Günther Albrecht, Ichaporia Nasli R, Kleinig Timothy, Kristoffersen Espen S, Lemmens Robin, De Maistre Emmanuel, Mirzaasgari Zahra, Payen Jean-Francois, Putaala Jukka, Petruzzellis Marco, Raposo Nicolas, Sadeghi-Hokmabadi Elyar, Schoenenberger Silvia, Umaiorubahan Meenakshisundaram, Sylaja Padmavathy N, van de Munckhof Anita, Sánchez van Kammen Mayte, Lindgren Erik, Jood Katarina, Scutelnic Adrian, Heldner Mirjam R, Poli Sven, Kruip Marieke J H A, Arauz Antonio, Conforto Adriana B, Aaron Sanjith, Middeldorp Saskia, Tatlisumak Turgut, Arnold Marcel, Coutinho Jonathan M, Ferro José M
Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Stroke Centre, Lisbon Central University Hospital Center, Lisbon, Portugal.
Eur J Neurol. 2023 May;30(5):1335-1345. doi: 10.1111/ene.15735. Epub 2023 Mar 5.
Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored.
Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included.
Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p < 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p < 0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent.
Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
疫苗诱导的免疫性血栓性血小板减少症所致的脑静脉窦血栓形成（CVST-VITT）是接种严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗后发生的一种药物不良反应。CVST-VITT患者常出现大面积脑出血，且很大一部分患者接受了减压手术。本文描述了接受减压手术的CVST-VITT患者的临床特征、治疗管理及预后情况，并探讨了这些患者院内死亡的预测因素。
使用了来自一个正在进行的国际登记处的数据，该登记处记录了2021年3月29日至2022年5月10日期间在接种SARS-CoV-2疫苗后28天内发生CVST的患者情况。纳入了Pavord等人（《新英格兰医学杂志》2021年；385: 1680 - 1689）定义的确诊、很可能和可能的VITT病例。
128例CVST-VITT患者中有34例（27%）接受了减压手术。手术组院内死亡率为22/34（65%），非手术组为27/94（29%）（p < 0.001）。在所有手术病例中，死亡原因均为脑疝。术前昏迷患者的死亡率最高（17/18，94%，而非昏迷患者为4/14，29%；p < 0.001）以及双侧瞳孔反射消失的患者（7/7，100%，单侧瞳孔有反应的患者为6/9，67%，双侧瞳孔有反应的患者为4/11，36%；p = 0.023）。术后影像学检查显示，19例（70%）患者的主要出血性病变恶化，16例（59%）患者出现新的出血性病变。在中位随访6个月时，入院后存活的接受手术的CVST-VITT患者中有8/10功能独立。
近三分之二接受手术的CVST-VITT患者在住院期间死亡。术前昏迷和双侧瞳孔反应缺失与较高的死亡率相关。幸存者通常实现了功能独立。
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