Universität zu Köln

Fervers, Philipp, Kottlors, Jonathan, Persigehl, Thorsten, Lennartz, Simon, Maus, Volker, Fischer, Sebastian, Styczen, Hanna, Deuschl, Cornelius, Schlamann, Marc, Mpotsaris, Anastasios, Zubel, Seraphine, Schroeter, Michael, Maintz, David, Fink, Gereon Rudolf and Abdullayev, Nuran ORCID: 0000-0003-4522-537X (2022). Meaningful use of imaging resources to rule out cerebral venous sinus thrombosis after ChAdOx1 COVID-19 vaccination: Evaluation of the AHA diagnostic algorithm with a clinical cohort and a systematic data review. J. Clin. Neurosci., 102. S. 5 - 13. OXFORD: ELSEVIER SCI LTD. ISSN 1532-2653

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Abstract

Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous thrombosis (CVST) is an improbable (0.0005%), however potentially lethal complication after ChAdOx1 vaccination. On the other hand, headache is among the most frequent side effects of ChAdOx1 (29.3%). In September 2021, the American Heart Association (AHA) suggested a diagnostic workflow to facilitate risk-adapted use of imaging resources for patients with neurological symptoms after ChAdOx1. We aimed to evaluate the AHA workflow in a retrospective patient cohort presenting at four primary care hospitals in Germany for neurological complaints after ChAdOx1. Scientific literature was screened for case reports of VITT with CVST after ChAdOx1, published until September 1st, 2021. One-hundred-thirteen consecutive patients (77 female, mean age 38.7 +/- 11.9 years) were evaluated at our institutes, including one case of VITT with CVST. Further 228 case reports of VITT with CVST are published in recent literature, which share thrombocytopenia (225/227 reported) and elevated d-dimer levels (100/101 reported). The AHA workflow would have recognized all VITT cases with CVST (100% sensitivity), the number needed to diagnose (NND) was 1:113. Initial evaluation of thrombocytopenia or elevated d-dimer levels would have lowered the NND to 1:68, without cost of sensitivity. Hence, we suggest that in case of normal thrombocyte and d-dimer levels, the access to further diagnostics should be limited by the established clinical considerations regardless of vaccination history.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fervers, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Kottlors, Jonathan UNSPECIFIED UNSPECIFIED UNSPECIFIED Persigehl, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Lennartz, Simon UNSPECIFIED UNSPECIFIED UNSPECIFIED Maus, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischer, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Styczen, Hanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Deuschl, Cornelius UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlamann, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED UNSPECIFIED UNSPECIFIED Zubel, Seraphine UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeter, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Maintz, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Fink, Gereon Rudolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Abdullayev, Nuran UNSPECIFIED orcid.org/0000-0003-4522-537X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-683698
DOI:	10.1016/j.jocn.2022.05.031
Journal or Publication Title:	J. Clin. Neurosci.
Volume:	102
Page Range:	S. 5 - 13
Date:	2022
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1532-2653
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Clinical Neurology; Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68369