Table 3. Clinical Course, Treatment, and Outcomes of Patients With Cerebral Venous Sinus Thrombosis (CVST) After SARS-CoV-2 Vaccination With and Without Thrombosis With Thrombocytopenia Syndrome (TTS).
| Treatment and outcome | Group, No./total No. (%) | ||
|---|---|---|---|
| TTS (n = 78) | No TTS (n = 38) | Control (n = 207) | |
| CVST treatment | |||
| Any anticoagulant treatment | 67/78 (86)a | 38/38 (100) | 200/206 (97.1) |
| Intensive care unit admission | 60/74 (81) | 8/38 (21) | 32/179 (17.9) |
| Endovascular treatment | 16/77 (21) | 1/38 (3) | 1/207 (0.5) |
| Hemicraniectomy | 23/77 (30) | 1/38 (3) | 10/207 (4.8) |
| Immunomodulation treatment | |||
| Any immunomodulation treatment | 52/78 (67) | NA | NA |
| Intravenous immunoglobulins | 47/78 (60) | NA | NA |
| Plasma exchange | 6/78 (8) | NA | NA |
| Corticosteroids | 25/78 (32) | NA | NA |
| Eculizumab | 2/78 (3) | NA | NA |
| Rituximab | 1/78 (1) | NA | NA |
| Platelet transfusion | 20/78 (26) | NA | NA |
| Because of neurosurgical intervention | 13/78 (17) | NA | NA |
| Outcomes | |||
| Any concomitant thromboembolism | 25/70 (36) | 2/35 (6) | 10/206 (4.9) |
| Splanchnic vein thrombosis | 10/70 (14) | 1/35 (3) | 0 |
| Deep vein thrombosis | 6/70 (9) | 0 | 3/206 (1.5) |
| Pulmonary embolism | 16/70 (23) | 0 | 3/206 (1.5) |
| Pelvic vein thrombosis | 6/70 (9) | 1/35 (3) | 0 |
| Other thrombosis | 6/70 (9)b | 1/35 (3)c | 1/206 (0.5) |
| Any major bleeding complicationd | 9/76 (12) | 3/37 (8) | 9/206 (4.4) |
| New intracranial hemorrhage | 8/76 (11) | 3/37 (8) | ND |
| Other major bleeding | 4/76 (5)e | 0 | ND |
| Mortality at discharge | 36/76 (47) | 2/37 (5) | 8/207 (3.9) |
Abbreviations: NA, not applicable; ND, not determined.
a
Reasons for withholding anticoagulant treatment included early death (n = 7), intracranial hemorrhage (n = 3), and CVST diagnosed at autopsy (n = 1).
b
Kidney vein (n = 1), inferior vena cava (n = 3), aortic arch thrombus (n = 1), ventricular thrombus (n = 1), myocardial infarction (n = 2), and basilar artery (n = 1).
c
Inferior vena cava thrombosis and brainstem ischemic stroke (n = 1).
d
According to the criteria of the International Society on Thrombosis and Haemostasis.
e
Adrenal (n = 2), intraocular (n = 1), and thigh (n = 1).