Introduction

The common reported adverse effects of COVID-19 vaccination consist of the injection site's local reaction followed by several non-specific flu-like symptoms. However, rare cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST) after viral vector vaccines (ChAdOx1 nCoV-19 vaccine, Ad26.COV2 vaccine) have been reported. Herein we systemically reviewed the reported cases of CVST and VITT following the COVID-19 vaccination.

Methods

This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched PubMed until May 19, 2021, and the following Keywords were used: COVID Vaccine & Neurology, AstraZeneca COVID vaccine, ChAdOx1 nCoV-19 COVID vaccine, AZD1222 COVID vaccine, Janssen COVID vaccine, Johnson & Johnson COVID vaccine, Ad26.COV2 COVID vaccine. The authors evaluated the abstracts and titles of each article for screening and inclusion. English reports about post-vaccine CVST and VITT in humans were collected.

Results

Until May 19, we found 877 articles with the searched terms. We found 12 articles, which overall present clinical features of 36 patients with CVST and VITT after the ChAdOx1 nCoV-19 vaccine. Moreover, two articles were noted, which present 13 patients with CVST and VITT after Ad26.COV2 vaccine. The majority of the patients were females. Symptom onset occurred within one week after the first dose of vaccination (Range 4–19 days). Headache was the most common presenting symptom. Intracerebral hemorrhage (ICH) and/or Subarachnoid hemorrhage (SAH) were reported in 49% of the patients. The platelet count of the patients was between 5 and 127 cells×10⁹/l, PF4 IgG Assay and d-Dimer were positive in the majority of the reported cases. Among 49 patients with CVST, at least 19 patients died (39%) due to complications of CVST and VITT.

Conclusion

Health care providers should be familiar with the clinical presentations, pathophysiology, diagnostic criteria, and management consideration of this rare but severe and potentially fatal complication of the COVID-19 vaccination. Early diagnosis and quick initiation of the treatment may help to provide patients with a more favorable neurological outcome.

中文翻译：

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COVID-19疫苗接种后疫苗诱导的免疫性血栓性血小板减少症和脑静脉窦血栓形成；系统回顾

介绍

COVID-19 疫苗接种的常见不良反应包括注射部位的局部反应以及随后出现的几种非特异性流感样症状。然而，有报道称在接种病毒载体疫苗（ChAdOx1 nCoV-19 疫苗、Ad26.COV2 疫苗）后出现疫苗诱导的免疫性血栓性血小板减少症 (VITT) 和脑静脉窦血栓形成 (CVST) 的罕见病例。在此，我们系统地回顾了 COVID-19 疫苗接种后报告的 CVST 和 VITT 病例。

方法

本系统评价是根据系统评价和荟萃分析 (PRISMA) 声明的首选报告项目进行的。我们搜索了 PubMed 直到 2021 年 5 月 19 日，并使用了以下关键词：COVID Vaccine & Neurology, AstraZeneca COVID vaccine, ChAdOx1 nCoV-19 COVID vaccine, AZD1222 COVID vaccine, Janssen COVID vaccine, Johnson & Johnson COVID vaccine, Ad26.COV2 COVID疫苗。作者评估了每篇文章的摘要和标题以进行筛选和收录。收集了关于人类接种疫苗后 CVST 和 VITT 的英文报告。

结果

截至 5 月 19 日，我们共找到 877 篇符合搜索条件的文章。我们找到了 12 篇文章，总体介绍了 36 名 CVST 和 VITT 患者在接种 ChAdOx1 nCoV-19 疫苗后的临床特征。此外，还有两篇文章提到了 13 名在 Ad26.COV2 疫苗接种后出现 CVST 和 VITT 的患者。大多数患者是女性。第一剂疫苗接种后一周内出现症状（范围 4-19 天）。头痛是最常见的主诉症状。49% 的患者报告了脑出血 (ICH) 和/或蛛网膜下腔出血 (SAH)。患者血小板计数为5~127个细胞×10 ⁹/l、PF4 IgG 检测和 d-二聚体在大多数报告病例中呈阳性。在 49 名 CVST 患者中，至少有 19 名患者 (39%) 死于 CVST 和 VITT 并发症。

结论

卫生保健提供者应熟悉 COVID-19 疫苗接种这种罕见但严重且可能致命的并发症的临床表现、病理生理学、诊断标准和管理注意事项。早期诊断和快速开始治疗可能有助于为患者提供更有利的神经学结果。