Case series/case reports (Indigo)
In this article the authors aimed to estimate the incidence of cerebral sinus and venous thrombosis (CVT) within one month from first-dose administration and the frequency of vaccine-induced immune thrombotic thrombocytopenia (VITT) as the underlying mechanism after vaccination with BNT162b2, ChAdOx1, and mRNA-1273, in Germany. A web-based questionnaire was e-mailed to all Departments of Neurology. The authors asked to report cases of CVT within one month of a COVID-19 vaccination. Other cerebral events could also be reported. Incidence rates of CVT were calculated by using official statistics of nine German States. A total of 45 CVT cases were reported. In addition, 9 primary ischemic strokes, 4 primary intracerebral hemorrhages, and 4 other neurological events were recorded. Of the CVT patients, 35 (77.8%) were female, and 36 (80.0%) were below the age of 60 years. Fifty-three events were observed after vaccination with ChAdOx1 (85.5%), 9 after BNT162b2 (14.5%), and none after mRNA-1273 vaccination. After 7,126,434 first vaccine doses, the incidence rate of CVT within one month from first dose administration was 0.55 (95% CI, 0.38-0.78) per 100,000 person-months (which corresponds to a risk of CVT within the first 31 days of 0.55 per 100,000 individuals) for all vaccines and 1.52 (1.00-2.21) for ChAdOx1 (after 2,320,535 ChAdOx1 first doses). The adjusted incidence rate ratio was 9.68 (3.46-34.98) for ChAdOx1 compared to mRNA-based vaccines and 3.14 (1.22-10.65) for women compared to non-women. In 26/45 patients with CVT (57.8%), VITT was graded highly probable. The authors concluded that given an incidence of 0.02–0.15 per 100,000 person-months for CVT in the general population, these findings point towards a higher risk for CVT after ChAdOx1 vaccination, especially for women.
Schulz JB, Berlit P, Diener HC, Gerloff C, Greinacher A, Klein C, Petzold GC, Piccininni M, Poli S, Röhrig R, Steinmetz H, Thiele T, Kurth T; DGN SARS-CoV-2 Vaccination Study Group. COVID-19 vaccine-associated cerebral venous thrombosis in Germany. Ann Neurol. 2021 Jul 19. doi: 10.1002/ana.26172.