European Telemedicine Clinic SL, Barcelona, Spain.
Australian Telemedicine Clinic Pty Ltd, Sydney, Australia.
J Thromb Thrombolysis. 2023 Nov;56(4):548-554. doi: 10.1007/s11239-023-02883-x. Epub 2023 Aug 20.
No well-established criteria exist for assessing the risk of cerebral venous sinus thrombosis (CVST). Here, we sought to gain an understanding of CVST cases and associated risk factors, based on the rates of emergency CT venographies (CTVs) performed after hours. Furthermore, we aimed to assess possible correlations between CVST rates and COVID-19, including at the start of the COVID-19 vaccination campaign. We collected reports of emergency CTVs performed after hours at 56 Swedish hospitals between 1/1/2019 and 12/31/2022, and divided them into five groups: (I) from 1/1/2019 to 1/31/2020, before the emergence of COVID-19 cases in Sweden; (II) from 2/1/2020 to 12/26/2020, after the emergence of COVID-19 but before vaccination rollout; (III) from 12/27/2020 to 7/28/2021, from the start of the COVID-19 vaccination campaign until 50% of the adult population in Sweden had been vaccinated; (IV) from 7/29/2021 to 2/1/2022, from when 50% of the adult population was vaccinated until restrictions were lifted; and (V) from 2/2/2022 to 12/31/2022, after restriction measures were suspended. For all included patients, we collected information on demographics and clinical history, including pregnancy, recent partum, and use of oral contraceptives or post-menopausal hormone replacement therapy. In total, we collected 430 reports (92% female, 8% male). The CVST positivity rate was 22.2% in men vs. 2.3% in women. None of the pregnant (n = 49) or postpartum (n = 12) women had CVST positivity. The frequency of CTV examinations was lowest in group 2; during this period, the average time between patients being imaged was 7 days. The frequency of CTV examinations was highest in group IV; during this period, a patient underwent this type of scan every 1.5 days, on average. The frequency of CVST-positive scans was lowest in group II; during this period, a positive case was found every 66 days, on average. The frequency of CVST-positive scans was highest in group IV; during this period, a positive case was found every 62 days, on average, and no statistical difference with respect to group II was observed. Pregnancy and recent partum were not significant risk factors for CVST. The elevated CVST positivity rate observed during the height of the COVID-19 pandemic suggested that patients with less likelihood for positive CVST had fewer emergency visits. The positivity rate did not increase with the start of the COVID-19 pandemic or the rollout of COVID-19 vaccination.
目前尚无评估脑静脉窦血栓形成（CVST）风险的既定标准。在这里，我们根据非工作时间进行的紧急 CT 静脉造影（CTV）的比率，旨在了解 CVST 病例和相关危险因素。此外，我们旨在评估 COVID-19 与 CVST 率之间的可能相关性，包括 COVID-19 疫苗接种运动开始时。我们收集了 2019 年 1 月 1 日至 2022 年 12 月 31 日期间在瑞典 56 家医院进行的非工作时间紧急 CTV 报告，并将其分为五组：（I）从 1/1/2019 至 1/31/2020 年，在瑞典出现 COVID-19 病例之前；（II）从 2/1/2020 年至 12/26/2020 年，在出现 COVID-19 但疫苗接种开始之前；（III）从 12/27/2020 年至 7/28/2021 年，从 COVID-19 疫苗接种运动开始到瑞典 50%的成年人口接种疫苗；（IV）从 7/29/2021 年至 2/1/2022 年，从 50%的成年人口接种疫苗到取消限制；（V）从 2/2/2022 年至 12 月 31 日，在暂停限制措施后。对于所有纳入的患者，我们收集了人口统计学和临床病史信息，包括妊娠、产后和使用口服避孕药或绝经后激素替代疗法。总共有 430 份报告（92%为女性，8%为男性）。男性的 CVST 阳性率为 22.2%，而女性为 2.3%。没有怀孕的（n=49）或产后的（n=12）女性出现 CVST 阳性。组 2 中的 CTV 检查频率最低；在此期间，患者之间的平均成像时间为 7 天。组 IV 中的 CTV 检查频率最高；在此期间，平均每 1.5 天对患者进行一次此类扫描。组 II 中的 CVST 阳性扫描频率最低；在此期间，平均每 66 天发现一个阳性病例。组 IV 中的 CVST 阳性扫描频率最高；在此期间，平均每 62 天发现一个阳性病例，与组 II 相比无统计学差异。妊娠和产后不是 CVST 的显著危险因素。在 COVID-19 大流行高峰期观察到的 CVST 阳性率升高表明，不太可能出现阳性 CVST 的患者急诊就诊次数减少。阳性率并未随着 COVID-19 大流行的开始或 COVID-19 疫苗接种的推出而增加。
