Abstract：
OBJECTIVE: Cerebral venous sinus thrombosis (CVST) has been reported as a rare adverse event in association with thrombosis-thrombocytopenia syndrome (TTS) following COVID-19 vaccination.
METHODS: We performed a systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases, with the aim to calculate (1) the odds ratio of TTS-CVST versus non-TTS-CVST after vector-based vaccines and (2) after non-vector-based vaccines, (3) the in-hospital mortality ratio of TTS-CVST compared to non-TTS-CVST; and (4) the dependency or death at discharge among TTS-CVST compared to non-TTS-CVST cases.
RESULTS: Two eligible studies were included in the meta-analysis, comprising a total of 211 patients with CVST associated with COVID-19 vaccination. Vector-based COVID-19 vaccination was associated with a higher likelihood of TTS-associated CVST than with non-TTS-CVST (OR: 52.34, 95% CI 9.58-285.98). TTS-CVST was also associated with higher likelihood of in-hospital mortality (OR: 13.29; 95% CI 3.96-44.60) and death or dependency at discharge compared to non-TTS-CVST (OR: 6.70; 95% CI 3.15-14.26). TTS-CVST was recorded with a shorter interval between vaccination and symptom onset [Mean Difference (MD):-6.54 days; 95% CI - 12.64 to - 0.45], affecting younger patients (MD:-9.00 years; 95% CI - 14.02 to - 3.99) without risk factors for thromboses (OR:2.34; 95% CI 1.26-4.33), and was complicated more frequently with intracerebral hemorrhage (OR:3.60; 95% CI 1.31-9.87) and concomitant thromboses in other sites (OR:11.85; 95% CI 3.51-39.98) compared to non-TTS-CVST cases.
CONCLUSIONS: TTS-CVST following COVID-19 vaccination has distinct risk factor profile, clinical phenotype and prognosis compared to non-TTS-CVST. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS-CVST cases following COVID-19 vaccination.
METHODS: We performed a systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases, with the aim to calculate (1) the odds ratio of TTS-CVST versus non-TTS-CVST after vector-based vaccines and (2) after non-vector-based vaccines, (3) the in-hospital mortality ratio of TTS-CVST compared to non-TTS-CVST; and (4) the dependency or death at discharge among TTS-CVST compared to non-TTS-CVST cases.
RESULTS: Two eligible studies were included in the meta-analysis, comprising a total of 211 patients with CVST associated with COVID-19 vaccination. Vector-based COVID-19 vaccination was associated with a higher likelihood of TTS-associated CVST than with non-TTS-CVST (OR: 52.34, 95% CI 9.58-285.98). TTS-CVST was also associated with higher likelihood of in-hospital mortality (OR: 13.29; 95% CI 3.96-44.60) and death or dependency at discharge compared to non-TTS-CVST (OR: 6.70; 95% CI 3.15-14.26). TTS-CVST was recorded with a shorter interval between vaccination and symptom onset [Mean Difference (MD):-6.54 days; 95% CI - 12.64 to - 0.45], affecting younger patients (MD:-9.00 years; 95% CI - 14.02 to - 3.99) without risk factors for thromboses (OR:2.34; 95% CI 1.26-4.33), and was complicated more frequently with intracerebral hemorrhage (OR:3.60; 95% CI 1.31-9.87) and concomitant thromboses in other sites (OR:11.85; 95% CI 3.51-39.98) compared to non-TTS-CVST cases.
CONCLUSIONS: TTS-CVST following COVID-19 vaccination has distinct risk factor profile, clinical phenotype and prognosis compared to non-TTS-CVST. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS-CVST cases following COVID-19 vaccination.
摘要：
目的：据报道，脑静脉窦血栓形成（CVST）是与COVID-19疫苗接种后血栓形成-血小板减少综合征（TTS）相关的罕见不良事件。
方法：我们对研究者发起的包括确诊的CVST病例的登记进行了系统评价和荟萃分析，目的是计算（1）基于载体的疫苗后TTS-CVST与非TTS-CVST的比值比和（2）非基于载体的疫苗后，(3)TTS-CVST与非TTS-CVST相比的院内死亡率;(4)TTS-CVST与非TTS-CVST相比的出院时的依赖性或死亡。
结果：两项符合条件的研究纳入荟萃分析，共211例与COVID-19疫苗接种相关的CVST患者。与非TTS-CVST相比，基于载体的COVID-19疫苗接种与TTS相关CVST的可能性更高(OR：52.34，95%CI9.58-285.98)。与非TTS-CVST(OR:6.70;95%CI3.15-14.26)相比，TTS-CVST与住院死亡率(OR:13.29;95%CI3.96-44.60)和出院时死亡或依赖相关。记录的TTS-CVST在疫苗接种和症状发作之间的间隔较短[平均差（MD）：-6.54天；95％CI-12.64至-0.45]，影响年轻患者（MD：-9.00岁；95％CI-14.02至-3.99），无血栓形成危险因素（OR：2.34；95％CI1.26-4.33），与非TTS-CVST病例相比，并发脑出血（OR：3.60;95％CI1.31-9.87）和其他部位合并血栓形成（OR：11.85;95％CI3.51-39.98）的频率更高。
结论：COVID-19疫苗接种后的TTS-CVST具有明显的危险因素特征，与非TTS-CVST相比，临床表型和预后。需要进一步的流行病学数据来评估不同治疗策略对COVID-19疫苗接种后TTS-CVST病例结局的影响。
方法：我们对研究者发起的包括确诊的CVST病例的登记进行了系统评价和荟萃分析，目的是计算（1）基于载体的疫苗后TTS-CVST与非TTS-CVST的比值比和（2）非基于载体的疫苗后，(3)TTS-CVST与非TTS-CVST相比的院内死亡率;(4)TTS-CVST与非TTS-CVST相比的出院时的依赖性或死亡。
结果：两项符合条件的研究纳入荟萃分析，共211例与COVID-19疫苗接种相关的CVST患者。与非TTS-CVST相比，基于载体的COVID-19疫苗接种与TTS相关CVST的可能性更高(OR：52.34，95%CI9.58-285.98)。与非TTS-CVST(OR:6.70;95%CI3.15-14.26)相比，TTS-CVST与住院死亡率(OR:13.29;95%CI3.96-44.60)和出院时死亡或依赖相关。记录的TTS-CVST在疫苗接种和症状发作之间的间隔较短[平均差（MD）：-6.54天；95％CI-12.64至-0.45]，影响年轻患者（MD：-9.00岁；95％CI-14.02至-3.99），无血栓形成危险因素（OR：2.34；95％CI1.26-4.33），与非TTS-CVST病例相比，并发脑出血（OR：3.60;95％CI1.31-9.87）和其他部位合并血栓形成（OR：11.85;95％CI3.51-39.98）的频率更高。
结论：COVID-19疫苗接种后的TTS-CVST具有明显的危险因素特征，与非TTS-CVST相比，临床表型和预后。需要进一步的流行病学数据来评估不同治疗策略对COVID-19疫苗接种后TTS-CVST病例结局的影响。
