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Zarimeidani F, Rahmati R, Mokary Y, Azizollahi S, Ebrahimi R, Raeisi Shahraki H, Bayati A, Jivad N. Sex differences in clinical profile and risk factors of cerebral venous sinus thrombosis at a high-altitude area: A 10-year retrospective cross-sectional study. Medicine (Baltimore) 2024; 103:e38711. [PMID: 39151491 PMCID: PMC11332771 DOI: 10.1097/md.0000000000038711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/04/2024] [Accepted: 06/06/2024] [Indexed: 08/19/2024] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon disorder with an increased mortality risk. Data on the sex-specific clinical profile and related factors can be practical in clinical diagnosis and management. Thus, we aimed to assess CVST characteristics in Shahrekord, the most elevated city among the centers of the provinces of Iran, referred to as the Roof of Iran. In this retrospective cross-sectional study, we reviewed the hospital records of 127 CVST patients between April 2013 and June 2023 to analyze the demographic characteristics, clinical profile, disease outcomes, and risk factors. STROBE guidelines were used to report this study. Females comprised 65.3% of the study. Females' age was almost equal to male patients (37.51 ± 13.95 years vs 38.09 ± 16.18 years, P = .832), and more than half of the patients (59.1%) were married. Clinical characteristics showed no significant difference between the sexes. In contrast to males, females had multifarious risk factors. However, the main risk factors for both sexes were CVST and hypertension. Most patients had 1 sinus affected (55.9%), and the location of thrombosis was mainly in the right transverse sinus in males (38.63%) and superior sagittal sinus in females (33.73%). However, those with more than 2 affected sinuses were mostly women. Regarding radiological findings, sinusitis was significantly seen in men (18.18% vs 3.61%). Among laboratory data, females significantly had higher erythrocyte sedimentation rate levels than males (21.66 ± 24.39 vs 9.60 ± 8.55). This study indicates that among CVST patients, men have significantly higher occurrences of sinusitis, and higher levels of erythrocyte sedimentation rate were observed in women. However, no other significant differences were found. More extensive studies are essential to fully comprehend the sex-specific aspects of CVST.
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Affiliation(s)
- Fatemeh Zarimeidani
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rahem Rahmati
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Yousef Mokary
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Setayesh Azizollahi
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rasool Ebrahimi
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hadi Raeisi Shahraki
- Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Asghar Bayati
- Department of Neurology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Nahid Jivad
- Department of Neurology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Murugaiyan S, Sivaji AR, Julin A. Alcohol Emergence: A Study on Various Risk Factors and Clinical Characteristics in Patients With Cerebral Venous Sinus Thrombosis From a Tertiary Care Hospital in South India. Cureus 2024; 16:e65528. [PMID: 39188469 PMCID: PMC11346587 DOI: 10.7759/cureus.65528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
Objective and aim Cerebral venous thrombosis (CVT) is a rare condition with significant morbidity and mortality risk involving the thrombosis of cerebral veins and dural sinuses. Its symptoms vary widely, ranging from headaches to focal neurological deficits, posing significant challenges to its diagnosis. Various contributing factors are involved in its etiology, some of which are gender specific. The clinical presentation varies widely and differs based on geographic distribution. This diversity makes CSVT challenging to diagnose, as it manifests in different ways and requires keen medical observation. Early detection is crucial for prognosis, as addressing the underlying cause can prevent further complications. This study aims to identify various causative factors and clinical presentations observed in individuals diagnosed with cerebral venous sinus thrombosis (CVST). Material and methods This prospective observational study was conducted at the Department of Neurology for a year, involving 55 patients admitted to the Neurology OPD/ER. Sample selection was done using non-probability convenience sampling. Patients aged 18 years or older presenting with symptoms indicative of CVST, confirmed by neuroimaging, were included in the study. Patients with arterial stroke, space-occupying lesions, and CVST related to pregnancy or puerperium were excluded. A detailed and structured medical history was obtained, and relevant blood investigations were conducted to find the underlying etiology. Results The study population had a mean age of 33 ± 2.04 years. The gender distribution is inclined towards 78.1% males due to the exclusion of pregnancy- or puerperium-related CVST to identify other predominant risk factors. 87.2% of the patients presented acutely, primarily with headaches (94.54%), and 67.2% had seizures within a week of admission. Prothrombotic conditions (45.4%) were the prevalent risk factor in the study group. Second, infections accounted for 21.8%. Alcoholism was seen in 52.7% of the study population, but its correlation with CVST remains unclear. The superior sagittal sinus (34.5%) and transverse sinus (20%) were commonly involved in neuroimaging, with multiple sinus involvement observed in some cases. Conclusion Cerebral venous sinus thrombosis (CVST) presents with a wide range of symptoms, making diagnosis challenging. However, with modern imaging and lab tests, we can detect and treat it effectively, often with positive outcomes and minimal long-term effects. This study seeks to understand the risk factors associated with CVST, contributing to its diagnosis and management.
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Affiliation(s)
- Sivaji Murugaiyan
- Neurology, Tamil Nadu Government Multi Super Specialty Hospital, Chennai, IND
| | - Akshaya Rathin Sivaji
- Internal Medicine, Panimalar Medical College Hospital & Research Institute, Chennai, IND
| | - Asir Julin
- Neurology, Tamil Nadu Government Multi Super Specialty Hospital, Chennai, IND
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Uzun G, Zlamal J, Althaus K, Bevot A, Hennersdorf F, Wolska N, Jock A, Kern J, Icheva V, Poli S, Ernemann U, Neu A, Bakchoul T. Cerebral venous sinus thrombosis and thrombocytopenia due to heparin-independent anti-PF4 antibodies after adenovirus infection. Haematologica 2024; 109:2010-2015. [PMID: 37881869 PMCID: PMC11141643 DOI: 10.3324/haematol.2023.284127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Not available.
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Affiliation(s)
- Günalp Uzun
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital of Tübingen
- Center for Clinical Transfusion Medicine
| | - Jan Zlamal
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital of Tübingen
- Center for Clinical Transfusion Medicine
| | - Karina Althaus
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital of Tübingen
- Center for Clinical Transfusion Medicine
| | - Andrea Bevot
- Department of Neuropediatrics and Developmental Medicine, University Children’s Hospital, University of Tübingen
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen
| | - Nina Wolska
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital of Tübingen
| | - Anna Jock
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children’s Hospital, University of Tübingen
| | - Jan Kern
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children’s Hospital, University of Tübingen
| | - Vanya Icheva
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children’s Hospital, University of Tübingen
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital of Tübingen
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen
| | - Andreas Neu
- Department of Pediatric Endocrinology and Diabetes, University Children’s Hospital, University of Tübingen, Tübingen, Germany
| | - Tamam Bakchoul
- Institute for Clinical and Experimental Transfusion Medicine, University Hospital of Tübingen
- Center for Clinical Transfusion Medicine
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Netha A, Mazhar S, Azhar A, Moeez A, Choradia A, Mohtashim A, Anees U, Ejaz U, Tariq MU, Jawad S. Effectiveness of rivaroxaban in preventing cerebral venous thromboembolism: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:2098-2104. [PMID: 38576935 PMCID: PMC10990339 DOI: 10.1097/ms9.0000000000001689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024] Open
Abstract
Background Cerebral venous thromboembolism (CVT) poses a significant risk of venous infarction and haemorrhage, which can lead to neurological deficits and, in severe cases, even death. The optimal treatment regimen for patients with CVT remains unclear. Methods MEDLINE, Embase, Google Scholar, Web of Science (WoS), and Cochrane Central databases were searched for randomized controlled trials (RCTs) and observational studies assessing the efficacy and safety of rivaroxaban in patients with CVT. All-site venous thromboembolism (VTE), risk of clinically relevant non-major bleeding, incidence of partial recanalization, complete recanalization and major haemorrhage were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs. Results The analysis included 1 RCT and 3 observational studies containing 211 patients. Compared to vitamin K antagonists (VKAs), rivaroxaban did not significantly decrease the all-site VTE [RR 0.31 (95% CI 0.01, 8.43); P=0.49, I2=0%]. Compared with VKAs, patients on rivaroxaban did not show a significantly reduced risk of recurrent cerebral venous thrombosis. In terms of incidence of partial recanalization, there was no discernible difference between rivaroxaban and VKAs [RR 0.90 (95% CI 0.66, 1.22); P=0.49, I2=0%]. There was no discernible difference in incidence of complete recanalization [RR 0.98 (95% CI 0.32, 3.03); P=0.97, I2=28%] and incidence of major haemorrhage [RR 0.19 (95% CI 0.01, 4.54); P=0.30]. Conclusion Rivaroxaban was found to have similar efficacy to VKAs. Due to its lower risk of severe bleeding and no need for INR monitoring, rivaroxaban may be a preferable treatment option for CVT.
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Affiliation(s)
- Aadarsh Netha
- Department of Medicine, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Tamilnadu, India
| | - Saad Mazhar
- Department of Medicine, King Edward Medical University
| | - Aima Azhar
- Department of Medicine, Fatima Jinnah Medical University
| | - Abdul Moeez
- Department of Medicine, Services Institute of Medical Sciences
| | - Aakash Choradia
- Department of Medicine, Tribhuwan University, Kathmandu, Nepal
| | - Ali Mohtashim
- Department of Medicine, Allama Iqbal Medical College, Lahore
| | - Usama Anees
- Department of Medicine, Quaid-e-Azam Medical College, Bahawalpur
| | - Umer Ejaz
- Department of Medicine, Rawalpindi Medical College, Rawalpindi
| | | | - Sayed Jawad
- Department of Medicine, Kabul University of Medical Sciences, Kabul, Afghanistan
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Lloyd PC, Lufkin B, Moll K, Ogilvie RP, McMahill-Walraven CN, Beachler DC, Kelman JA, Shi X, Hobbi S, Amend KL, Djibo DA, Shangguan S, Shoaibi A, Sheng M, Secora A, Zhou CK, Kowarski L, Chillarige Y, Forshee RA, Anderson SA, Muthuri S, Seeger JD, Kline A, Reich C, MaCurdy T, Wong HL. Incidence rates of thrombosis with thrombocytopenia syndrome (TTS) among adults in United States commercial and Medicare claims databases, 2017-2020. Vaccine 2024; 42:2004-2010. [PMID: 38388240 DOI: 10.1016/j.vaccine.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Increased risk of thrombosis with thrombocytopenia syndrome (TTS) following adenovirus vector-based COVID-19 vaccinations has been identified in passive surveillance systems. TTS incidence rates (IRs) in the United States (U.S.) are needed to contextualize reports following COVID-19 vaccination. METHODS We estimated annual and monthly IRs of overall TTS, common site TTS, and unusual site TTS for adults aged 18-64 years in Carelon Research and MarketScan commercial claims (2017-Oct 2020), CVS Health and Optum commercial claims (2019-Oct 2020), and adults aged ≥ 65 years using CMS Medicare claims (2019-Oct 2020); IRs were stratified by age, sex, and race/ethnicity (CMS Medicare). RESULTS Across data sources, annual IRs for overall TTS were similar between Jan-Dec 2019 and Jan-Oct 2020. Rates were higher in Medicare (IRs: 370.72 and 365.63 per 100,000 person-years for 2019 and 2020, respectively) than commercial data sources (MarketScan IRs: 24.21 and 24.06 per 100,000 person-years; Optum IRs: 32.60 and 31.29 per 100,000 person-years; Carelon Research IRs: 24.46 and 26.16 per 100,000 person-years; CVS Health IRs: 30.31 and 30.25 per 100,000 person-years). Across years and databases, common site TTS IRs increased with age and were higher among males. Among adults aged ≥ 65 years, the common site TTS IR was highest among non-Hispanic black adults. Annual unusual site TTS IRs ranged between 2.02 and 3.04 (commercial) and 12.49 (Medicare) per 100,000 person-years for Jan-Dec 2019; IRs ranged between 1.53 and 2.67 (commercial) and 11.57 (Medicare) per 100,000 person-years for Jan-Oct 2020. Unusual site TTS IRs were higher in males and increased with age in commercial data sources; among adults aged ≥ 65 years, IRs decreased with age and were highest among non-Hispanic American Indian/Alaska native adults. CONCLUSION TTS IRs were generally similar across years, higher for males, and increased with age. These rates may contribute to surveillance of post-vaccination TTS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cindy Ke Zhou
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | | | - Thomas MaCurdy
- Acumen LLC, Burlingame, CA, USA; Department of Economics, Stanford University, Stanford, CA, USA
| | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
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Zhang Y, Bissola AL, Treverton J, Hack M, Lychacz M, Kwok S, Arnold A, Nazy I. Vaccine-Induced Immune Thrombotic Thrombocytopenia: Clinicopathologic Features and New Perspectives on Anti-PF4 Antibody-Mediated Disorders. J Clin Med 2024; 13:1012. [PMID: 38398325 PMCID: PMC10889051 DOI: 10.3390/jcm13041012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare yet severe adverse complication first identified during the global vaccination effort against SARS-CoV-2 infection, predominantly observed following administration of the ChAdOx1-S (Oxford-AstraZeneca) and Ad26.CoV2.S (Johnson & Johnson/Janssen) adenoviral vector-based vaccines. Unlike other anti-platelet factor 4 (PF4) antibody-mediated disorders, such as heparin-induced thrombocytopenia (HIT), VITT arises with the development of platelet-activating anti-PF4 antibodies 4-42 days post-vaccination, typically featuring thrombocytopenia and thrombosis at unusual sites. AIM To explore the unique properties, pathogenic mechanisms, and long-term persistence of VITT antibodies in patients, in comparison with other anti-PF4 antibody-mediated disorders. DISCUSSION This review highlights the complexity of VITT as it differs in antibody behavior and clinical presentation from other anti-PF4-mediated disorders, including the high incidence rate of cerebral venous sinus thrombosis (CVST) and the persistence of anti-PF4 antibodies, necessitating a re-evaluation of long-term patient care strategies. The nature of VITT antibodies and the underlying mechanisms triggering their production remain largely unknown. CONCLUSION The rise in awareness and subsequent prompt recognition of VITT is paramount in reducing mortality. As vaccination campaigns continue, understanding the role of adenoviral vector-based vaccines in VITT antibody production is crucial, not only for its immediate clinical implications, but also for developing safer vaccines in the future.
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Affiliation(s)
- Yi Zhang
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Anna-Lise Bissola
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Jared Treverton
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Michael Hack
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Mark Lychacz
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Sarah Kwok
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
| | - Addi Arnold
- Department of Pathology and Laboratory Medicine, Western University, London, ON N6A 5A5, Canada;
| | - Ishac Nazy
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (Y.Z.); (J.T.); (M.H.); (S.K.)
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.-L.B.); (M.L.)
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
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Pishbin E, Ziyaei M, Vafadar Moradi E, Foroughipour M, Javadzadeh R, Foroughian M. Ten-year Causes of Cerebral Venous Sinus Thrombosis in Patients Referred to Ghaem Hospital from 2009 to 2019. Bull Emerg Trauma 2024; 12:8-14. [PMID: 38689792 PMCID: PMC11057450 DOI: 10.30476/beat.2024.100510.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 05/02/2024] Open
Abstract
Objective Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disorder characterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple risk factors and casualties, and its epidemiological picture should be investigated. Methods This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebral vein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009 and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinical symptoms and causes were documented and contrasted according to demographics. Results During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with women accounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followed by seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness (3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). The most commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%), malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factors between the two genders, with the exception that all cases of fasting were in women, and the differences were significant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography (MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the site of the conflict between the two genders (p<0.05). Conclusion The findings of the present study showed that deep vein thrombosis occurred mainly in women and manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site of involvement.
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Affiliation(s)
- Elham Pishbin
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Ziyaei
- Department of Emergency Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Elnaz Vafadar Moradi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Foroughipour
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rahim Javadzadeh
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Algarni SA, ALGhasab NS, Alharbi MS, Albarrak A, Alanezi AA, Al Shehri HM. Sex Differences and Clinical Outcomes of Patients with Coronavirus Disease 2019 Infection and Cerebral Venous Sinus Thrombosis: A Systematic Review. Clin Appl Thromb Hemost 2024; 30:10760296241240748. [PMID: 38551022 PMCID: PMC10981232 DOI: 10.1177/10760296241240748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare neurovascular condition that has been observed in individuals with coronavirus disease 2019 (COVID-19). This systematic review aimed to explore the sex differences and characteristics of concurrent COVID-19 and CVST cases. A total of 212 CVST patients were included in the study. Women with CVST had a slightly higher mean age compared to men (47.359 years vs 46.08 years). Women were more likely to report symptoms such as fever (56.1%) and decreased sense of smell or taste (71.4%), while men more frequently experienced nausea or vomiting (55.6%), headache (62.9%), and seizures (72%). Notably, current smokers, who were predominantly men, had a higher occurrence of CVST. On the other hand, women had a higher likelihood of CVST risk factors such as oral contraceptive pill (OCP) use and autoimmune diseases. Treatment approaches also showed sex-based differences. Unfractionated heparin was administered more often to women with CVST (63.2%). The in-hospital mortality rate for CVST patients was 21.3%, with men having a significantly higher mortality rate than women (65.2% vs 34.8%, P = .027). Survival analysis revealed that factors such as smoking history, diabetes mellitus, hypertension, OCP use, COVID-19 symptoms, CVST symptoms, and the need for intubation significantly influenced survival outcomes. Understanding these sex differences in COVID-19-related CVST is crucial for accurate diagnosis and effective management, ultimately leading to improved patient outcomes. Our findings highlight the importance of considering sex as a factor in the evaluation and treatment of individuals with COVID-19 and concurrent CVST.
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Affiliation(s)
- Saleh A. Algarni
- Department of Neuroscience, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Naif S. ALGhasab
- Department of Internal Medicine, Medical Collage, Ha’il University, Ha’il, Saudi Arabia
| | - Mohammed S. Alharbi
- Department of Internal Medicine, Medical Collage, Ha’il University, Ha’il, Saudi Arabia
| | - Anas Albarrak
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmad A. Alanezi
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
- Department of Pediatrics, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Hamdan M. Al Shehri
- Department of Internal Medicine, Medical Collage, Najran University, Najran, Saudi Arabia
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9
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Frommeyer TC, Wu T, Gilbert MM, Brittain GV, Fuqua SP. Cerebral Venous Sinus Thrombosis Following an mRNA COVID-19 Vaccination and Recent Oral Contraceptive Use. Life (Basel) 2023; 13:life13020464. [PMID: 36836821 PMCID: PMC9961502 DOI: 10.3390/life13020464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Rising concerns of cerebral venous sinus thrombosis (CVST) and other forms of venous thromboembolism have been associated with the SARS-CoV-2 vaccinations. Adverse effects with vector-based vaccines are well documented in the literature, while less is known about the mRNA vaccines. This report documents a case of CVST in a 32-year-old female patient who received her second Pfizer mRNA COVID-19 vaccination 16 days prior to hospital admission and had started oral combined contraceptives approximately 4 months beforehand. Clinicians should be cognizant of the possibility that mRNA vaccines, when combined with other risk factors like oral contraceptive pill use, may enhance one's hypercoagulable status.
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Affiliation(s)
- Timothy C. Frommeyer
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
- Correspondence:
| | - Tongfan Wu
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Michael M. Gilbert
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Garrett V. Brittain
- Department of Pharmacology & Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Stephen P. Fuqua
- Department of Neurology, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
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10
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Arachchillage DJ, Crossette‐Thambiah C, Asmar N, Ramji S, Laffan M. Cerebral vein thrombosis after ChAdOx1 nCov-19 vaccination: Long-term outcome of four patients. Res Pract Thromb Haemost 2022; 6:e12844. [PMID: 36408296 PMCID: PMC9667410 DOI: 10.1002/rth2.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Deepa J. Arachchillage
- Centre for Haematology, Department of Immunology and InflammationImperial College LondonLondonUK
- Department of HaematologyImperial College Healthcare NHS TrustLondonUK
| | - Christina Crossette‐Thambiah
- Centre for Haematology, Department of Immunology and InflammationImperial College LondonLondonUK
- Department of HaematologyImperial College Healthcare NHS TrustLondonUK
| | - Namir Asmar
- Department of neuroradiologyImperial College Healthcare NHS TrustLondonUK
| | - Saipriya Ramji
- Department of neuroradiologyImperial College Healthcare NHS TrustLondonUK
| | - Mike Laffan
- Centre for Haematology, Department of Immunology and InflammationImperial College LondonLondonUK
- Department of HaematologyImperial College Healthcare NHS TrustLondonUK
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Kubatka P, Mazurakova A, Koklesova L, Samec M, Sokol J, Samuel SM, Kudela E, Biringer K, Bugos O, Pec M, Link B, Adamkov M, Smejkal K, Büsselberg D, Golubnitschaja O. Antithrombotic and antiplatelet effects of plant-derived compounds: a great utility potential for primary, secondary, and tertiary care in the framework of 3P medicine. EPMA J 2022; 13:407-431. [PMID: 35990779 PMCID: PMC9376584 DOI: 10.1007/s13167-022-00293-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/29/2022]
Abstract
Thromboembolism is the third leading vascular disease, with a high annual incidence of 1 to 2 cases per 1000 individuals within the general population. The broader term venous thromboembolism generally refers to deep vein thrombosis, pulmonary embolism, and/or a combination of both. Therefore, thromboembolism can affect both – the central and peripheral veins. Arterial thromboembolism causes systemic ischemia by disturbing blood flow and oxygen supply to organs, tissues, and cells causing, therefore, apoptosis and/or necrosis in the affected tissues. Currently applied antithrombotic drugs used, e.g. to protect affected individuals against ischemic stroke, demonstrate significant limitations. For example, platelet inhibitors possess only moderate efficacy. On the other hand, thrombolytics and anticoagulants significantly increase hemorrhage. Contextually, new approaches are extensively under consideration to develop next-generation antithrombotics with improved efficacy and more personalized and targeted application. To this end, phytochemicals show potent antithrombotic efficacy demonstrated in numerous in vitro, ex vivo, and in vivo models as well as in clinical evaluations conducted on healthy individuals and persons at high risk of thrombotic events, such as pregnant women (primary care), cancer, and COVID-19-affected patients (secondary and tertiary care). Here, we hypothesized that specific antithrombotic and antiplatelet effects of plant-derived compounds might be of great clinical utility in primary, secondary, and tertiary care. To increase the efficacy, precise patient stratification based on predictive diagnostics is essential for targeted protection and treatments tailored to the person in the framework of 3P medicine. Contextually, this paper aims at critical review toward the involvement of specific classes of phytochemicals in antiplatelet and anticoagulation adapted to clinical needs. The paper exemplifies selected plant-derived drugs, plant extracts, and whole plant foods/herbs demonstrating their specific antithrombotic, antiplatelet, and fibrinolytic activities relevant for primary, secondary, and tertiary care. One of the examples considered is antithrombotic and antiplatelet protection specifically relevant for COVID-19-affected patient groups.
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Affiliation(s)
- Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Alena Mazurakova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Lenka Koklesova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Marek Samec
- Department of Pathological Physiology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Juraj Sokol
- Department of Hematology and Transfusion Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Samson Mathews Samuel
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, 24144 Doha, Qatar
| | - Erik Kudela
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Kamil Biringer
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | | | - Martin Pec
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Barbara Link
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Marian Adamkov
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Karel Smejkal
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, 61200 Brno, Czech Republic
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, 24144 Doha, Qatar
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
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