Estimated background rate of CVST with thrombocytopenia is 0.1 per million per month. In this article the authors assessed the age-stratified risk of CVST with and without thrombocytopenia after SARS- CoV-2 vaccination. They estimated the absolute risk of CVST with and without thrombocytopenia within 28 days of first dose of four SARS-CoV-2 vaccinations, using data from the European Medicines Agency’s EudraVigilance database (until 13 June 2021). As a denominator, they used data on vaccine delivery from 31 European countries. For 22.8 million adults from 25 countries, they estimated the absolute risk of CVST after the first dose of ChAdOx1 nCov-19 per age category. The absolute risk of CVST within 28 days of first dose vaccination was 7.5 (95%CI 6.9-8.3), 0.7 (95%CI 0.2-2.4), 0.6 (95%CI 0.5-0.7) and 0.6 (95%CI 0.3-1.1) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2 and mRNA-1273, respectively. The absolute risk of CVST with thrombocytopenia within 28 days of first dose vaccination was 4.4 (95%CI 3.9-4.9), 0.7 (95%CI 0.2-2.4), 0.0 (95%CI 0.0-0.1) and 0.0 (95%CI 0.0-0.2) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2 and mRNA-1273, respectively. In recipients of ChAdOx1 nCov-19, the absolute risk of CVST, both with and without thrombocytopenia, was the highest in the 18-24 years age group (7.3 per million, 95%CI 2.8- 18.8 and 3.7 per million, 95%CI 1.0-13.3, respectively). The risk of CVST with thrombocytopenia in ChAdOx1 nCov-19 recipients was the lowest in the age group≥70 years (0.2, 95%CI 0.0-1.3). Age <60 compared to ≥60 was a predictor for CVST with thrombocytopenia (incidence rate ratio 5.79; 95%CI 2.98-11.24, p<0.001). The risk of CVST with thrombocytopenia within 28 days of first dose vaccination with ChAdOx1 nCov-19 was higher in younger age groups. The risk of CVST with thrombocytopenia was slightly increased in patients receiving Ad26.COV2.S, compared with the estimated background risk. The authors concluded that the risk of CVST with thrombocytopenia was not increased in recipients of SARS-CoV-2 mRNA vaccines.
Katarzyna Krzywicka, Anita van de Munckhof, Mayte Sánchez van Kammen, Mirjam R Heldner, Katarina Jood, Erik Lindgren, Turgut Tatlisumak, Jukka Putaala, Johanna A Kremer Hovinga, Saskia Middeldorp, Marcel M Levi, Charlotte Cordonnier, Marcel Arnold, Aeilko H Zwinderman, José M Ferro, Jonathan M Coutinho, Diana Aguiar de Sousa. Age-Stratified Risk of Cerebral Venous Sinus Thrombosis After SARS-CoV-2 Vaccination. Neurology Dec 2021, 10.1212/WNL.0000000000013148;
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Cross-sectional case-control studies