Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.
Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Stroke. 2023 Oct;18(9):1112-1120. doi: 10.1177/17474930231182901. Epub 2023 Jun 30.
Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs.
We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs.
We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs).
Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], = 0.039).
The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
腺病毒 COVID-19 疫苗在中低收入国家（LMICs）广泛使用。值得注意的是，疫苗引起的免疫性血栓性血小板减少性紫癜（CVST-VITT）导致的脑静脉窦血栓形成病例在 LMICs 中很少报道。
我们研究了 LMICs 中 CVST-VITT 的频率、表现、治疗和结局。
我们报告了一项关于 COVID-19 疫苗接种后 CVST 的国际登记处的数据。VITT 根据 Pavord 标准进行分类。我们将来自 LMICs 的 CVST-VITT 病例与来自高收入国家（HICs）的病例进行比较。
截至 2022 年 8 月，共报告 228 例 CVST 病例，其中 63 例来自 LMICs（均为中低收入国家[MICs]：巴西、中国、印度、伊朗、墨西哥、巴基斯坦、土耳其）。其中 32 例（51%）符合 VITT 标准，而 165 例 HICs 中则有 103 例符合 VITT 标准。MICs 中仅有 5 例（16%）CVST-VITT 病例为明确的 VITT，主要是因为经常未检测到抗血小板因子 4 抗体。中位年龄为 26 岁（四分位距[IQR] 20-37），而 MICs 中女性比例为 25/32（78%），HICs 中为 77/103（75%）。MICs 患者的诊断时间晚于 HICs 患者（1/32 [3%] vs. 65/103 [63%] 于 2021 年 5 月前诊断）。临床表现，包括颅内出血，以及静脉注射免疫球蛋白的使用均大致相似。MICs 中的住院死亡率较低（7/31 [23%，95%CI 11-40%]），而 HICs 中则较高（44/102 [43%，95%CI 34-53%]，=0.039）。
尽管腺病毒疫苗广泛使用，但从 LMICs 报告的 CVST-VITT 病例数量较少。MICs 和 HICs 中 CVST-VITT 病例的临床表现和治疗大致相似，而 MICs 患者的死亡率较低。
