Mahadevan Joshua J, Psaltis Peter J, Thrift Amanda G, Kleinig Timothy J
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Department of Neurology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
BMJ Neurol Open. 2024 May 15;6(1):e000605. doi: 10.1136/bmjno-2023-000605. eCollection 2024.
The identification of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia (VITT) followed the recognition of a hitherto uncommon clinical syndrome frequently associated with cerebral venous sinus thrombosis (CVST), termed 'thrombosis with thrombocytopenia' syndrome (TTS). While anecdotally recognised as rare, the background incidence of TTS is unknown. We therefore aimed to investigate the background incidence of CVST with TTS in a large, well-defined population-based CVST cohort.
We performed an analysis of our previously obtained retrospective population-based cohort of patients with CVST from Adelaide, Australia (2005-2011, comprising an adult population of 953 390) to identify the background incidence of CVST associated with TTS.
Among 105 people with CVST, the background population-based incidence of TTS-associated CVST was 1.2 per million per year (95% CI 0.5 to 2.4). A single case of a severe CVST VITT-like syndrome with multiorgan thrombosis was identified, occurring 3 weeks postrotavirus infection.
In our population-based study, the background incidence of CVST with associated TTS was very low, and the sole clinically severe case with multiorgan thrombosis occurred following a rotaviral precipitant. Our study establishes a benchmark against which to measure future potential 'TTS' clusters and suggests that viruses other than adenovirus may trigger this syndrome.
在认识到一种此前不常见的临床综合征（常与脑静脉窦血栓形成（CVST）相关，称为“血小板减少伴血栓形成”综合征（TTS））之后，对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗诱导的免疫性血栓性血小板减少症（VITT）进行了识别。虽然TTS在个别病例中被认为罕见，但其背景发病率尚不清楚。因此，我们旨在调查一个大型、明确的基于人群的CVST队列中CVST合并TTS的背景发病率。
我们对之前从澳大利亚阿德莱德获得的基于人群的CVST患者回顾性队列（2005 - 2011年，成年人口953390人）进行分析，以确定与TTS相关的CVST的背景发病率。
在105例CVST患者中，基于人群的TTS相关CVST的背景发病率为每年百万分之1.2（95%置信区间0.5至2.4）。识别出1例严重的CVST VITT样综合征伴多器官血栓形成病例，发生在轮状病毒感染后3周。
在我们基于人群的研究中，CVST合并相关TTS的背景发病率非常低，唯一临床严重的多器官血栓形成病例发生在轮状病毒感染之后。我们的研究建立了一个基准，可据此衡量未来潜在的“TTS”聚集情况，并表明腺病毒以外的病毒可能引发该综合征。
