Cerebral Venous Sinus Thrombosis After SARS-CoV-2 Vaccination

Quick Takes

  • Cerebral sinus vein thrombosis is rare following AstraZeneca or Johnson & Johnson COVID-19 vaccination (0.9-3.6 per million).
  • Cerebral sinus vein thrombosis is far more common among patients hospitalized with COVID-19 (207 per million) than following vaccination or in the general hospitalized patients (2.4 per million).

Study Questions:

What is the rate of cerebral venous sinus thrombosis (CVST) associated with vaccination to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) versus coronavirus disease 2019 (COVID-19) infection and the general incidence in the US population?

Methods:

The authors used data from The Medicines and Healthcare products Regulatory Agency (from the United Kingdom) and the US Centers for Disease Control and Prevention to report on the number of CVST events per persons having received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. They also used data from a multinational study of cerebrovascular events to report rates of CVST among patients hospitalized for COVID-19, and CVST from the Nationwide Inpatient Sample database between March–April 2018.

Results:

As of April 14, 2021, there were 77 cases of CVST out of 21.2 million recipients of AstraZeneca vaccine (3.6 per million, 99% confidence interval [CI], 2.7-4.8 per million). As of April 13, 2021, there were 6 cases of CVST out of 6.85 million recipients of Johnson & Johnson vaccine (0.9 per million, 95% CI, 0.2-2.3 per million). In the multinational COVID-19 registry, 3 of 14,483 patients with COVID-19 had CVST (207.1 per million, 95% CI, 23.3-757.7 per million). In 2018, the rate of CVST among hospitalized US patients was 2.4 per million (95% CI, 2.1-2.6 per million).

Conclusions:

The authors concluded that the relative frequency of CVST following COVID-19 vaccination is markedly lower than for patients hospitalized with COVID-19, but not substantially higher than for general hospitalized patients.

Perspective:

This study helps to put the risk of vaccine-induced thrombotic thrombocytopenia (VITT, also known as the Thrombotic and Thrombocytopenia Syndrome [TTS]) into perspective. From a thrombotic standpoint, the risk of CVST is approximately 100 times lower following vaccination than for patients who are hospitalized with COVID-19. However, the combination of CVST with an autoimmune thrombocytopenia is clearly very rare outside the setting of AstraZeneca or Johnson & Johnson COVID-19 vaccination. Nonetheless, COVID-19 has a high degree of morbidity and mortality, including thrombosis complication, and therefore, vaccination should be encouraged.

Clinical Topics: Prevention, Vascular Medicine

Keywords: Adenoviridae, Adenoviridae Infections, Coronavirus, COVID-19, Delivery of Health Care, Inpatients, Mass Vaccination, Primary Prevention, Purpura, Thrombocytopenic, Idiopathic, SARS-CoV-2, Sinus Thrombosis, Intracranial, Thrombocytopenia, Thrombosis, Vaccination, Vascular Diseases


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