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Decompressive Surgery in Cerebral Venous Sinus Thrombosis Due to Vaccine‐Induced Immune Thrombotic Thrombocytopenia

2023-05Journal article Open access
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dc.contributor.authorKrzywicka, K
dc.contributor.authorAguiar de Sousa, D
dc.contributor.authorCordonnier, C
dc.contributor.authorBode, F
dc.contributor.authorField, T
dc.contributor.authorMichalski, D
dc.contributor.authorPelz, J
dc.contributor.authorSkjelland, M
dc.contributor.authorWiedmann, M
dc.contributor.authorZimmermann, J
dc.contributor.authorWittstock, M
dc.contributor.authorZanotti, B
dc.contributor.authorCiccone, A
dc.contributor.authorBandettini di Poggio, M
dc.contributor.authorBorhani‐Haghighi, A
dc.contributor.authorChatterton, S
dc.contributor.authorAujayeb, A
dc.contributor.authorDevroye, A
dc.contributor.authorDizonno, V
dc.contributor.authorGeeraerts, T
dc.contributor.authorGiammello, F
dc.contributor.authorGünther, A
dc.contributor.authorIchaporia, N
dc.contributor.authorKleinig, T
dc.contributor.authorKristoffersen, E
dc.contributor.authorLemmens, R
dc.contributor.authorDe Maistre, E
dc.contributor.authorMirzaasgari, Z
dc.contributor.authorPayen, JF
dc.contributor.authorPutaala, J
dc.contributor.authorPetruzzellis, M
dc.contributor.authorRaposo, N
dc.contributor.authorSadeghi‐Hokmabadi, E
dc.contributor.authorSchoenenberger, S
dc.contributor.authorUmaiorubahan, M
dc.contributor.authorSylaja, P
dc.contributor.authorvan de Munckhof, A
dc.contributor.authorSánchez van Kammen, M
dc.contributor.authorLindgren, E
dc.contributor.authorJood, K
dc.contributor.authorScutelnic, A
dc.contributor.authorHeldner, M
dc.contributor.authorPoli, S
dc.contributor.authorKruip, M
dc.contributor.authorArauz, A
dc.contributor.authorConforto, A
dc.contributor.authorAaron, S
dc.contributor.authorMiddeldorp, S
dc.contributor.authorTatlisumak, T
dc.contributor.authorArnold, M
dc.contributor.authorCoutinho, J
dc.contributor.authorFerro, J
dc.date.accessioned2024-05-09T15:42:24Z
dc.date.available2024-05-09T15:42:24Z
dc.date.issued2023-05
dc.description.abstractBackground and purpose: Cerebral venous sinus thrombosis due to vaccine-induced immune 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 reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent. Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationEur J Neurol . 2023 May;30(5):1335-1345.pt_PT
dc.identifier.doi10.1111/ene.15735pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4896
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherWileypt_PT
dc.subjectHSJ NEUpt_PT
dc.subjectCOVID-19 Vaccines* / adverse effectspt_PT
dc.subjectCOVID-19* / prevention & controlpt_PT
dc.subjectComapt_PT
dc.subjectPurpura, Thrombocytopenic, Idiopathic* / chemically inducedpt_PT
dc.subjectHumanspt_PT
dc.subjectPurpura, Thrombocytopenic, Idiopathic* / surgerypt_PT
dc.subjectSinus Thrombosis, Intracranial* / chemically inducedpt_PT
dc.subjectSinus Thrombosis, Intracranial* / surgerypt_PT
dc.subjectThrombocytopenia* / chemically inducedpt_PT
dc.subjectThrombocytopenia* / surgerypt_PT
dc.titleDecompressive Surgery in Cerebral Venous Sinus Thrombosis Due to Vaccine‐Induced Immune Thrombotic Thrombocytopeniapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1345pt_PT
oaire.citation.issue5pt_PT
oaire.citation.startPage1335pt_PT
oaire.citation.titleEuropean Journal of Neurologypt_PT
oaire.citation.volume30pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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