Brain venography performance following the pause of Ad.26.COV2.S COVID-19 vaccine administration

Cases of cerebral venous thrombosis (CVT) associated with vaccine induced thrombotic thrombocytopenia (VITT) were reported following administration of the adenoviral vector COVID-19 vaccines, resulting in a pause in Ad.26.COV2.S vaccine administration in the United States, beginning on April 14, 202...

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Veröffentlicht in:Journal of thrombosis and thrombolysis 2022-02, Vol.53 (2), p.359-362
Hauptverfasser: Long, Clayton V., Clemente, Jonathan D., Singh, Sam, Strong, Dale, Rhoten, Jeremy B., Prasad, Tanushree, Asimos, Andrew W.
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container_end_page 362
container_issue 2
container_start_page 359
container_title Journal of thrombosis and thrombolysis
container_volume 53
creator Long, Clayton V.
Clemente, Jonathan D.
Singh, Sam
Strong, Dale
Rhoten, Jeremy B.
Prasad, Tanushree
Asimos, Andrew W.
description Cases of cerebral venous thrombosis (CVT) associated with vaccine induced thrombotic thrombocytopenia (VITT) were reported following administration of the adenoviral vector COVID-19 vaccines, resulting in a pause in Ad.26.COV2.S vaccine administration in the United States, beginning on April 14, 2021. We aimed to quantify and characterize an anticipated increase in brain venograms performed in response to this pause. Brain venogram cases were retrospectively identified during the three-week period following the vaccine pause and during the same calendar period in 2019. For venograms performed in 2021, we compared COVID vaccinated to unvaccinated patients. There was a 262% increase in venograms performed between 2019 (n = 26) and 2021 (n = 94), compared to only a 19% increase in all radiologic studies. Fifty-seven percent of patients in 2021 had a history of COVID-19 vaccination, with the majority being Ad.26.COV2.S. All patients diagnosed with CVT were unvaccinated. COVID vaccinated patients lacked platelet or D-dimer measurements consistent with VITT. Significantly more vaccinated versus unvaccinated patients had a headache (94% vs 70%, p = 0.0014), but otherwise lacked compelling CVT presentations, such as decreased/altered consciousness (7% vs 23%, p = 0.036), neurologic deficit (28% vs 48%, p = 0.049), and current/recent pregnancy (2% vs 28%, p = 0.0003). We found a dramatic increase in brain venograms performed following publicity of rare COVID-19 vaccine associated CVT cases, with no CVTs identified in vaccinated patients. Clinicians should carefully consider if brain venogram performance is indicated in COVID-19 vaccinated patients lacking thrombocytopenia and D-dimer elevation, especially without other compelling CVT risk factors or symptoms.
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We aimed to quantify and characterize an anticipated increase in brain venograms performed in response to this pause. Brain venogram cases were retrospectively identified during the three-week period following the vaccine pause and during the same calendar period in 2019. For venograms performed in 2021, we compared COVID vaccinated to unvaccinated patients. There was a 262% increase in venograms performed between 2019 (n = 26) and 2021 (n = 94), compared to only a 19% increase in all radiologic studies. Fifty-seven percent of patients in 2021 had a history of COVID-19 vaccination, with the majority being Ad.26.COV2.S. All patients diagnosed with CVT were unvaccinated. COVID vaccinated patients lacked platelet or D-dimer measurements consistent with VITT. 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subjects Brain
Cardiology
Coronaviruses
COVID-19 - prevention & control
COVID-19 vaccines
COVID-19 Vaccines - adverse effects
Hematology
Humans
Intracranial Thrombosis - etiology
Medicine
Medicine & Public Health
Phlebography - adverse effects
Retrospective Studies
Risk factors
Thrombocytopenia
Thrombocytopenia - etiology
Thrombosis
Thrombosis - etiology
United States
Vaccination - adverse effects
Vaccines
title Brain venography performance following the pause of Ad.26.COV2.S COVID-19 vaccine administration
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