Table 2.
Radiological, diagnostics, clinical findings and outcomes by vaccine dose and CDC case classification.
| Characteristic | All N = 170 | Vaccine |
CDC classification |
|||
|---|---|---|---|---|---|---|
| ChAdOx1-S dose 1 N = 147 | ChAdOx1-S dose 2 N = 23 | Tier 1 N = 51 | Tier 2 N = 53 | Neither N = 66 | ||
| Radiological findings (thrombus details on initial imaging) | ||||||
| Type | ||||||
| Arterial only | 7 (4.1%) | 7 (4.8%) | 0 (0%) | 0 (0%) | 4 (7.5%) | 3 (4.5%) |
| Venous only | 154 (91%) | 132 (90%) | 22 (96%) | 46 (90%) | 46 (87%) | 62 (94%) |
| Both | 9 (5.3%) | 8 (5.4%) | 1 (4.3%) | 5 (9.8%) | 3 (5.7%) | 1 (1.5%) |
| Haemorrhagic | 23 (15%) | 23 (18%) | 0 (0%) | 16 (35%) | 5 (11%) | 2 (3.4%) |
| Number | ||||||
| Single | 101 (59%) | 90 (61%) | 11 (48%) | 33 (65%) | 33 (62%) | 35 (53%) |
| Multiple | 69 (41%) | 57 (39%) | 12 (52%) | 18 (35%) | 20 (38%) | 31 (47%) |
| Location | ||||||
| CVST | 31 (18%) | 30 (20%) | 1 (4.3%) | 31 (61%) | 0 (0%) | 0 (0%) |
| Cerebral artery | 7 (4.1%) | 6 (4.1%) | 1 (4.3%) | 2 (3.9%) | 4 (7.5%) | 1 (1.5%) |
| Neck vein (jugular) | 4 (2.4%) | 4 (2.7%) | 0 (0%) | 4 (7.8%) | 0 (0%) | 0 (0%) |
| Neck artery (carotid) | 4 (2.4%) | 4 (2.7%) | 0 (0%) | 2 (3.9%) | 2 (3.8%) | 0 (0%) |
| Coronary artery | 1 (0.6%) | 1 (0.7%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (1.5%) |
| Pulmonary artery | 96 (56%) | 77 (52%) | 19 (83%) | 13 (25%) | 35 (66%) | 48 (73%) |
| Splanchnic system | 21 (12%) | 20 (14%) | 1 (4.3%) | 21 (41%) | 0 (0%) | 0 (0%) |
| Renal artery | 1 (0.6%) | 1 (0.7%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (1.5%) |
| Aorta | 5 (2.9%) | 5 (3.4%) | 0 (0%) | 1 (2.0%) | 2 (3.8%) | 2 (3.0%) |
| DVT—any LL | 80 (47%) | 67 (46%) | 13 (57%) | 7 (14%) | 30 (57%) | 43 (65%) |
| DVT—proximal LL | 54 (32%) | 47 (32%) | 7 (30%) | 4 (7.8%) | 19 (36%) | 31 (47%) |
| DVT—distal LL | 26 (15%) | 20 (14%) | 6 (26%) | 3 (5.9%) | 11 (21%) | 12 (18%) |
| DVT—UL | 2 (1.2%) | 1 (0.7%) | 1 (4.3%) | 0 (0%) | 0 (0%) | 2 (3.0%) |
| Diagnostic findings | ||||||
| Platelets | ||||||
| <150 on initial | 160 (95%) | 137 (94%) | 23 (100%) | 49 (98%) | 49 (94%) | 62 (94%) |
| Initial, median (range) | 104 (7–296) | 97 (7–296) | 121 (34–261) | 90 (11–222) | 86 (7–296) | 124 (30–229) |
| Nadir, median (range) | 83 (6–150) | 76 (6–150) | 101 (34–146) | 50 (6–150) | 62 (7–150) | 111 (24–150) |
| >50% drop | 43 (29%) | 41 (32%) | 2 (9.5%) | 18 (38%) | 18 (41%) | 7 (12%) |
| Recovery, median (range) | 166 (86–373) | 168 (86–373) | 165 (151–232) | 166 (86–373) | 172 (123–296) | 165 (150–284) |
| Fibrinogen, median (range) | 3.80 (1.00–9.70) | 3.75 (1.00–9.70) | 4.80 (2.40–7.20) | 4.00 (1.00–7.90) | 3.40 (1.05–9.70) | 3.70 (1.40–7.50) |
| D-dimer (mg/L FEU), median (range) | 16 (2–137) | 17 (2–137) | 10 (2–125) | 20 (2–137) | 19 (2–128) | 12 (2–125) |
| D-dimer x ULN, median (range) | 33 (4–274) | 36 (4–274) | 26 (5–250) | 40 (4–274) | 38 (4–256) | 25 (4–250) |
| HIT ELISA | ||||||
| Positive | 87 (51%) | 80 (54%) | 7 (30%) | 34 (67%) | 53 (100%) | 0 (0%) |
| Negative | 74 (44%) | 60 (41%) | 14 (61%) | 17 (33%) | 0 (0%) | 57 (86%) |
| Not done | 9 (5.3%) | 7 (4.8%) | 2 (8.7%) | 0 (0%) | 0 (0%) | 9 (14%) |
| Positive OD readings, median (range) | 1.21 (0.20–3.25) | 1.32 (0.20–3.25) | 0.41 (0.34–2.28) | 1.08 (0.20–2.94) | 1.30 (0.20–3.25) | N/A |
| Clinical findings, management and outcomes | ||||||
| Timing | ||||||
| Asymptomatic | 10 (5.9%) | 9 (6.1%) | 1 (4.3%) | 2 (3.9%) | 5 (9.4%) | 3 (4.5%) |
| Time to symptom onset, median [IQR] | 11 [7–20] | 10 [7–18] | 15 [8–32] | 9 [7–16] | 10 [8–15] | 15 [8–29] |
| Symptom onset to admission, median [IQR] | 2.0 [0.0–7.0] | 2.0 [0.0–6.8] | 3.0 [1.0–7.5] | 2.0 [0.0–5.5] | 2.0 [0.0–6.0] | 2 [0.0–8.0] |
| Level of care | ||||||
| Hospital admission | 164 (96%) | 142 (97%) | 22 (96%) | 50 (98%) | 52 (98%) | 62 (94%) |
| Hospital length of stay, median [IQR] | 6 [3–13] | 6 [3–13] | 5 [4–10] | 11 [5–17] | 6 [3–14] | 4 [3–8] |
| ICU admission | 67 (39%) | 62 (42%) | 5 (22%) | 31 (61%) | 16 (30%) | 20 (30%) |
| Surgical intervention | 28 (16%) | 27 (18%) | 1 (4.3%) | 17 (33%) | 6 (11%) | 5 (7.6%) |
| Inpatient treatment | ||||||
| Anticoagulation (any) | 168 (99%) | 145 (99%) | 23 (100%) | 49 (96%) | 53 (100%) | 66 (100%) |
| Apixaban | 92 (54%) | 80 (54%) | 12 (52%) | 21 (41%) | 31 (58%) | 40 (61%) |
| Argatroban | 20 (12%) | 17 (12%) | 3 (13%) | 10 (20%) | 5 (9.4%) | 5 (7.6%) |
| Bivalirudin | 37 (22%) | 34 (23%) | 3 (13%) | 22 (43%) | 8 (15%) | 7 (11%) |
| Dabigatrin | 8 (4.7%) | 7 (4.8%) | 1 (4.3%) | 4 (7.8%) | 3 (5.7%) | 1 (1.5%) |
| Danaparoid | 7 (4.1%) | 6 (4.1%) | 1 (4.3%) | 3 (5.9%) | 2 (3.8%) | 2 (3%) |
| Enoxaparin | 30 (18%) | 23 (16%) | 7 (30%) | 0 (0%) | 13 (25%) | 17 (26%) |
| Fondaparinux | 44 (26%) | 40 (27%) | 4 (17%) | 14 (27%) | 17 (32%) | 13 (20%) |
| Heparin | 8 (4.7%) | 6 (4.1%) | 2 (8.7%) | 1 (2.0%) | 4 (7.5%) | 3 (4.5%) |
| Rivaroxaban | 41 (24%) | 35 (24%) | 6 (26%) | 12 (24%) | 12 (23%) | 17 (26%) |
| Warfarin | 15 (8.8%) | 9 (6.1%) | 6 (26%) | 7 (14%) | 4 (7.5%) | 4 (6.1%) |
| Blood products | ||||||
| IVIg | 113 (66%) | 101 (69%) | 12 (52%) | 47 (92%) | 35 (66%) | 31 (47%) |
| Platelet | 7 (4.1%) | 7 (4.8%) | 0 (0%) | 6 (12%) | 1 (1.9%) | 0 (0%) |
| FFP | 3 (1.8%) | 2 (1.4%) | 1 (4.3%) | 2 (3.9%) | 1 (1.9%) | 0 (0%) |
| Cryoprecipitate | 9 (5.3%) | 8 (5.4%) | 1 (4.3%) | 6 (12%) | 3 (5.7%) | 0 (0%) |
| PRBC | 9 (5.3%) | 8 (5.4%) | 1 (4.3%) | 4 (7.8%) | 2 (3.8%) | 3 (4.5%) |
| Plasmapheresis | 3 (1.8%) | 3 (2.0%) | 0 (0%) | 3 (5.9%) | 0 (0%) | 0 (0%) |
| Thrombolysis | 10 (5.9%) | 9 (6.1%) | 1 (4.3%) | 2 (3.9%) | 3 (5.7%) | 5 (7.6%) |
| Steroids | 35 (21%) | 33 (22%) | 2 (8.7%) | 13 (25%) | 13 (25%) | 9 (14%) |
| Inpatient complications | ||||||
| Haemorrhage | 22 (13%) | 19 (13%) | 3 (13%) | 11 (22%) | 5 (9.4%) | 6 (9.1%) |
| Further thromboses | 13 (7.6%) | 13 (8.8%) | 0 (0%) | 7 (14%) | 5 (9.4%) | 1 (1.5%) |
| Discharge destination/outcome | ||||||
| Dieda | 9 (5.3%) | 9 (6.1%) | 0 (0%) | 6 (12%) | 1 (1.9%) | 2 (3.0%) |
| Rehabilitation facility/long term care | 16 (9.4%) | 16 (11%) | 0 (0%) | 8 (16%) | 4 (7.5%) | 4 (6.1%) |
| Home | 145 (86%) | 122 (83%) | 23 (100%) | 37 (73%) | 48 (91%) | 60 (91%) |
| Outpatient therapy | ||||||
| Occupational therapy | 6/161 (3.7%) | 5/138 (3.6%) | 1/23 (4.3%) | 3/45 (6.7%) | 0/52 (0%) | 3/64 (4.7%) |
| Physiotherapy | 7/161 (4.3%) | 6/138 (4.3%) | 1/23 (4.3%) | 4/45 (8.9%) | 1/52 (1.9%) | 2/64 (3.1%) |
| Rehabilitation | 7/161 (4.3%) | 7/138 (5.1%) | 0/23 (0%) | 4/45 (8.9%) | 1/52 (1.9%) | 2/64 (3.1%) |
| Ongoing symptoms on discharge | 77/161 (48%) | 68/138 (49%) | 9/23 (39%) | 28/45 (62%) | 24/52 (46%) | 25/64 (39%) |
| Neurological | 20/161 (12%) | 18/138 (13%) | 2/23 (8.7%) | 13/45 (29%) | 4/52 (7.7%) | 2/64 (3.1%) |
| Cardiorespiratory | 27/161 (17%) | 22/138 (16%) | 5/23 (22%) | 2/45 (4.4%) | 12/52 (23%) | 13/64 (20%) |
| Gastrointestinal | 6/161 (3.7%) | 6/138 (4.3%) | 0/23 (0%) | 6/45 (13.3%) | 0/52 (0%) | 0/64 (0%) |
| Vascular | 20/161 (11%) | 17/138 (12%) | 3/23 (13%) | 1/45 (2.2%) | 5/52 (24%) | 14/64 (22%) |
| Discharge medications | ||||||
| Anticoagulation | 161/161 (100%) | 138/138 (100%) | 23/23 (100%) | 45/45 (100%) | 52/52 (100%) | 64/64 (100%) |
| Apixaban | 93/161 (58%) | 84/138 (61%) | 10/23 (4.3%) | 21/45 (47%) | 29/52 (56%) | 44/64 (69%) |
| Dabigatran | 7/161 (4.3%) | 6/138 (4.3%) | 1/23 (4.3%) | 3/45 (6.7%) | 3/52 (5.8%) | 1/64 (1.6%) |
| Enoxaparin | 1/161 (0.6%) | 0/138 (0%) | 1/23 (4.3%) | 0/45 (0%) | 0/52 (0%) | 1/64 (1.6%) |
| Fondaparinux | 7/161 (4.3%) | 7/138 (5.1%) | 0/23 (0%) | 5/45 (11%) | 2/52 (3.8%) | 0/64 (0%) |
| Rivaroxaban | 36/161 (22%) | 30/138 (22%) | 6/23 (26%) | 10/45 (22%) | 11/52 (21%) | 15/64 (23%) |
| Warfarin | 16/161 (10%) | 11/138 (8.0%) | 5/23 (22%) | 6/45 (13%) | 6/52 (12%) | 4/64 (6.3%) |
| Prednisone | 13/161 (8.1%) | 11/138 (8.0%) | 2/23 (8.7%) | 4/45 (8.9%) | 6/52 (11.5%) | 3/64 (4.7%) |
| Anti-seizure medication | 6/161 (3.7%) | 4/138 (2.9%) | 2/23 (8.7%) | 1/45 (2.2%) | 2/52 (3.8%) | 3/64 (4.7%) |
CVST = cerebral venous sinus thrombosis, DVT = deep vein thrombosis, FEU = fibrinogen equivalent units, FFP = fresh frozen plasma, HIT ELISA = heparin induced thrombocytopenia enzyme-linked immunosorbent assay, IQR = interquartile range, ICU = intensive care unit, IVIg = intravenous immunoglobulin, LL = lower limb, OD = optical density, PRBC = packed red blood cells, UL = upper limb, ULN = upper limit of normal.
a
This includes the 8 deaths assessed by the Therapeutic Goods Administration as being related to TTS, and one additional case where information from the coroner indicates that the death was caused by other health conditions and was not related to TTS. This case is included here as a death as the patient was not discharged as they died during their admission to hospital with probable TTS.