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

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],

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.

Déclaration de conflit d'intérêts

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.C. received honoraria from Boehringer-Ingelheim, AstraZeneca, Biogen, Bristol Myers Squibb; T.J.K. received cost-assistance from Boehringer-Ingelheim; T.S.F. receives study medication from Bayer Canada and honoraria from HLS Therapeutics; S.P. received support from BMS/Pfizer, Daiichi Sankyo, European Union, German Federal Joint Committee Innovation Fund, German Federal Ministry of Education and Research, Helena Laboratories, Werfen, Alexion, AstraZeneca, Bayer, Boehringer-Ingelheim, Portola; R.L. reports fees by Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic, Medpass; A.S. received grants from Swiss Heart Foundation; E.L. received grants from Swedish state, Swedish Neurologic Society, Elsa and Gustav Lindh’s Foundation, Wennerströms’ Foundation, P-O Ahl’s Foundation, Rune and Ulla Amlöv’s Foundation; A.G. received fees from Bayer Vital, Bristol Myers Squibb, Daiichi Sankyo; K.J. received grants from Swedish state; T.T. received fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, Inventiva, Portola Pharma; M.R.H. reports grants from Swiss Heart Foundation and Bangerter Foundation and Advisory Board participation for Amgen; M.A. reports fees from AstraZeneca, Bayer, Bristol Myers Squibb, Covidien, Daiichi Sankyo, Medtronic, Novartis, Pfizer, Amgen; D.A.S. reports travel support from Boehringer-Ingelheim, fees from Bayer, and Advisory Board participation for AstraZeneca; J.M.F. received fees from Boehringer-Ingelheim, Bayer, and Daiichi Sankyo and grants from Bayer; J.M.C. received grants from Boehringer-Ingelheim and Bayer and payments for DSMB participation by Bayer; the other authors have no disclosures.