Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia

Katarzyna Krzywicka; Diana Aguiar de Sousa; Charlotte J. Cordonnier; Felix S. Bode; Thalia Field; Dominik Michalski; Johann Pelz; Mona Skjelland; Markus Wiedmann; Julian Zimmermann; Matthias Wittstock; Bruno Zanotti; Alfonso Ciccone; Monica Bandettini di Poggio; Afshin Borhani-Haghighi; Sophie Chatterton; Avinash Aujayeb; Annemie Devroye; Vanessa Dizonno; Thomas Geeraerts; Fabrizio Giammello; Albrecht R. Guenther; Nasli Ichaporia; Timothy S. Kleinig; Espen Kristoffersen; Robin Lemmens; Emmanuel De Maistre; Zahra Mirzaasgari; Jean-Francois Payen; Jukka Putaala; Marco Petruzzellis; Nicolas Raposo; Elyar Sadeghi-Hokmabadi; Silvia Schoenenberger; Meenakshisundaram Umaiorubahan; Padmavathy N. Sylaja; Anita van de Munckhof; Mayte Sanchez van Kammen; Erik Lindgren; Katarina Jood; Adrian R. Scutelnic; Mirjam Heldner; Sven Poli; Marieke J. H. A. Kruip; Antonio B. Arauz; Adriana Conforto; Sanjith Aaron; Saskia Middeldorp; Turgut Tatlisumak; Marcel M. Arnold; Jonathan Coutinho; Jose M. Ferro

doi:10.1111/ene.15735

Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia

Katarzyna Krzywicka, Diana Aguiar de Sousa, Charlotte J. Cordonnier, Felix S. Bode, Thalia Field, Dominik Michalski, Johann Pelz, Mona Skjelland, Markus Wiedmann, Julian Zimmermann, Matthias Wittstock, Bruno Zanotti, Alfonso Ciccone, Monica Bandettini di Poggio, Afshin Borhani-Haghighi, Sophie Chatterton, Avinash Aujayeb, Annemie Devroye, Vanessa Dizonno, Thomas GeeraertsFabrizio Giammello, Albrecht R. Guenther, Nasli Ichaporia, Timothy S. Kleinig, Espen Kristoffersen, Robin Lemmens, Emmanuel De Maistre, Zahra Mirzaasgari, Jean-Francois Payen, Jukka Putaala, Marco Petruzzellis, Nicolas Raposo, Elyar Sadeghi-Hokmabadi, Silvia Schoenenberger, Meenakshisundaram Umaiorubahan, Padmavathy N. Sylaja, Anita van de Munckhof, Mayte Sanchez van Kammen, Erik Lindgren, Katarina Jood, Adrian R. Scutelnic, Mirjam Heldner, Sven Poli, Marieke J. H. A. Kruip, Antonio B. Arauz, Adriana Conforto, Sanjith Aaron, Saskia Middeldorp, Turgut Tatlisumak, Marcel M. Arnold, Jonathan Coutinho, Jose M. Ferro

Research output: Contribution to journal › Article › Scientific › peer-review

Abstract

Background and purpose: Cerebral venous sinus thrombosis due to vaccine-induced im-mune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in- hospital mortality in these patients are explored.Methods: Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV- 2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680–1689), were included.
Results: Decompressive surgery was performed in 34/128 (27%) patients with CVST- VITT. In- hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non- surgical group (p< 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p< 0.001) and bilaterally absent pupillary re-flexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bi-laterally reactive pupils; p= 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) pa-tients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived ad-mission were functionally independent.Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital ad-mission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.

Original language	English
Journal	European Journal of Neurology
Volume	30
Issue number	5
Pages (from-to)	1335-1345
Number of pages	11
ISSN	1351-5101
DOIs	https://doi.org/10.1111/ene.15735
Publication status	Published - May 2023
MoE publication type	A1 Journal article-refereed

Fields of Science

COVID-19 vaccinations
Brain death
Cerebral venous thrombosis
Coma
Surgery
3112 Neurosciences
3124 Neurology and psychiatry

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10.1111/ene.15735Licence: CC BY-NC-ND

Euro J of Neurology - 2023 - Krzywicka - Decompressive surgery in cerebral venous sinus thrombosis due to vaccine‐inducedFinal published version, 713 KBLicence: CC BY-NC-ND

Cite this

Krzywicka, K., de Sousa, D. A., Cordonnier, C. J., Bode, F. S., Field, T., Michalski, D., Pelz, J., Skjelland, M., Wiedmann, M., Zimmermann, J., Wittstock, M., Zanotti, B., Ciccone, A., di Poggio, M. B., Borhani-Haghighi, A., Chatterton, S., Aujayeb, A., Devroye, A., Dizonno, V., ... Ferro, J. M. (2023). Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. European Journal of Neurology, 30(5), 1335-1345. https://doi.org/10.1111/ene.15735

@article{1c084dcf83204e518dc6039c5b0107db,

title = "Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia",

abstract = "Background and purpose: Cerebral venous sinus thrombosis due to vaccine-induced im-mune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in- hospital mortality in these patients are explored.Methods: Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV- 2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680–1689), were included.Results: Decompressive surgery was performed in 34/128 (27%) patients with CVST- VITT. In- hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non- surgical group (p< 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p< 0.001) and bilaterally absent pupillary re-flexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bi-laterally reactive pupils; p= 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) pa-tients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived ad-mission were functionally independent.Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital ad-mission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.",

keywords = "COVID-19 vaccinations, Brain death, Cerebral venous thrombosis, Coma, Surgery, 3112 Neurosciences, 3124 Neurology and psychiatry",

author = "Katarzyna Krzywicka and {de Sousa}, {Diana Aguiar} and Cordonnier, {Charlotte J.} and Bode, {Felix S.} and Thalia Field and Dominik Michalski and Johann Pelz and Mona Skjelland and Markus Wiedmann and Julian Zimmermann and Matthias Wittstock and Bruno Zanotti and Alfonso Ciccone and {di Poggio}, {Monica Bandettini} and Afshin Borhani-Haghighi and Sophie Chatterton and Avinash Aujayeb and Annemie Devroye and Vanessa Dizonno and Thomas Geeraerts and Fabrizio Giammello and Guenther, {Albrecht R.} and Nasli Ichaporia and Kleinig, {Timothy S.} and Espen Kristoffersen and Robin Lemmens and {De Maistre}, Emmanuel and Zahra Mirzaasgari and Jean-Francois Payen and Jukka Putaala and Marco Petruzzellis and Nicolas Raposo and Elyar Sadeghi-Hokmabadi and Silvia Schoenenberger and Meenakshisundaram Umaiorubahan and Sylaja, {Padmavathy N.} and {van de Munckhof}, Anita and {van Kammen}, {Mayte Sanchez} and Erik Lindgren and Katarina Jood and Scutelnic, {Adrian R.} and Mirjam Heldner and Sven Poli and Kruip, {Marieke J. H. A.} and Arauz, {Antonio B.} and Adriana Conforto and Sanjith Aaron and Saskia Middeldorp and Turgut Tatlisumak and Arnold, {Marcel M.} and Jonathan Coutinho and Ferro, {Jose M.}",

year = "2023",

month = may,

doi = "10.1111/ene.15735",

language = "English",

volume = "30",

pages = "1335--1345",

journal = "European Journal of Neurology",

issn = "1351-5101",

publisher = "Wiley/Blackwell ",

number = "5",

}

Krzywicka, K, de Sousa, DA, Cordonnier, CJ, Bode, FS, Field, T, Michalski, D, Pelz, J, Skjelland, M, Wiedmann, M, Zimmermann, J, Wittstock, M, Zanotti, B, Ciccone, A, di Poggio, MB, Borhani-Haghighi, A, Chatterton, S, Aujayeb, A, Devroye, A, Dizonno, V, Geeraerts, T, Giammello, F, Guenther, AR, Ichaporia, N, Kleinig, TS, Kristoffersen, E, Lemmens, R, De Maistre, E, Mirzaasgari, Z, Payen, J-F, Putaala, J, Petruzzellis, M, Raposo, N, Sadeghi-Hokmabadi, E, Schoenenberger, S, Umaiorubahan, M, Sylaja, PN, van de Munckhof, A, van Kammen, MS, Lindgren, E, Jood, K, Scutelnic, AR, Heldner, M, Poli, S, Kruip, MJHA, Arauz, AB, Conforto, A, Aaron, S, Middeldorp, S, Tatlisumak, T, Arnold, MM, Coutinho, J & Ferro, JM 2023, 'Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia', European Journal of Neurology, vol. 30, no. 5, pp. 1335-1345. https://doi.org/10.1111/ene.15735

TY - JOUR

T1 - Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia

AU - Krzywicka, Katarzyna

AU - de Sousa, Diana Aguiar

AU - Cordonnier, Charlotte J.

AU - Bode, Felix S.

AU - Field, Thalia

AU - Michalski, Dominik

AU - Pelz, Johann

AU - Skjelland, Mona

AU - Wiedmann, Markus

AU - Zimmermann, Julian

AU - Wittstock, Matthias

AU - Zanotti, Bruno

AU - Ciccone, Alfonso

AU - di Poggio, Monica Bandettini

AU - Borhani-Haghighi, Afshin

AU - Chatterton, Sophie

AU - Aujayeb, Avinash

AU - Devroye, Annemie

AU - Dizonno, Vanessa

AU - Geeraerts, Thomas

AU - Giammello, Fabrizio

AU - Guenther, Albrecht R.

AU - Ichaporia, Nasli

AU - Kleinig, Timothy S.

AU - Kristoffersen, Espen

AU - Lemmens, Robin

AU - De Maistre, Emmanuel

AU - Mirzaasgari, Zahra

AU - Payen, Jean-Francois

AU - Putaala, Jukka

AU - Petruzzellis, Marco

AU - Raposo, Nicolas

AU - Sadeghi-Hokmabadi, Elyar

AU - Schoenenberger, Silvia

AU - Umaiorubahan, Meenakshisundaram

AU - Sylaja, Padmavathy N.

AU - van de Munckhof, Anita

AU - van Kammen, Mayte Sanchez

AU - Lindgren, Erik

AU - Jood, Katarina

AU - Scutelnic, Adrian R.

AU - Heldner, Mirjam

AU - Poli, Sven

AU - Kruip, Marieke J. H. A.

AU - Arauz, Antonio B.

AU - Conforto, Adriana

AU - Aaron, Sanjith

AU - Middeldorp, Saskia

AU - Tatlisumak, Turgut

AU - Arnold, Marcel M.

AU - Coutinho, Jonathan

AU - Ferro, Jose M.

PY - 2023/5

Y1 - 2023/5

N2 - Background and purpose: Cerebral venous sinus thrombosis due to vaccine-induced im-mune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in- hospital mortality in these patients are explored.Methods: Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV- 2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680–1689), were included.Results: Decompressive surgery was performed in 34/128 (27%) patients with CVST- VITT. In- hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non- surgical group (p< 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p< 0.001) and bilaterally absent pupillary re-flexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bi-laterally reactive pupils; p= 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) pa-tients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived ad-mission were functionally independent.Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital ad-mission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.

AB - Background and purpose: Cerebral venous sinus thrombosis due to vaccine-induced im-mune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in- hospital mortality in these patients are explored.Methods: Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV- 2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680–1689), were included.Results: Decompressive surgery was performed in 34/128 (27%) patients with CVST- VITT. In- hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non- surgical group (p< 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p< 0.001) and bilaterally absent pupillary re-flexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bi-laterally reactive pupils; p= 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) pa-tients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived ad-mission were functionally independent.Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital ad-mission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.

KW - COVID-19 vaccinations

KW - Brain death

KW - Cerebral venous thrombosis

KW - Coma

KW - Surgery

KW - 3112 Neurosciences

KW - 3124 Neurology and psychiatry

U2 - 10.1111/ene.15735

DO - 10.1111/ene.15735

M3 - Article

C2 - 36773014

VL - 30

SP - 1335

EP - 1345

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

IS - 5

ER -