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Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. | LitMetric

AI Article Synopsis

  • Adenovirus-based COVID-19 vaccines are widely used in low- and middle-income countries (LMICs), but cases of vaccine-induced cerebral venous sinus thrombosis (CVST) are rarely reported.
  • A study of 228 CVST cases showed 63 from LMICs, with 51% meeting vaccine-induced immune thrombotic thrombocytopenia (VITT) criteria, compared to 62% from high-income countries (HICs).
  • Although clinical manifestations were similar, in-hospital mortality was significantly lower in LMICs (23%) compared to HICs (43%), suggesting different outcomes despite similar treatment approaches.

Article Abstract

Background: 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.

Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs.

Methods: 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).

Results: 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).

Conclusions: 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10614174PMC
http://dx.doi.org/10.1177/17474930231182901DOI Listing

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