Frequency of Thrombocytopenia and Platelet Factor 4/Heparin Antibodies in Patients With Cerebral Venous Sinus Thrombosis Prior to the COVID-19 Pandemic.

Autor:	Sánchez van Kammen M; Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Heldner MR; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Brodard J; Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Scutelnic A; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Silvis S; Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands., Schroeder V; Experimental Haemostasis Group, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland., Kremer Hovinga JA; Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Middeldorp S; Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands., Levi M; National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom.; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Hiltunen S; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Lindgren E; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden., Mansour M; Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran., Arauz A; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico-City, Mexico., Barboza MA; Neurosciences Department, Hospital Dr R.A. Calderón Guardia, CCSS, San José, Costa Rica., Zuurbier SM; Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Aguiar de Sousa D; Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal., Ferro JM; Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal., Fischer U; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Field TS; Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada., Jood K; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden., Tatlisumak T; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden., Putaala J; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Arnold M; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Coutinho JM; Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2021 Jul 27; Vol. 326 (4), pp. 332-338.
DOI:	10.1001/jama.2021.9889
Abstrakt:	Importance: Cases of cerebral venous sinus thrombosis in combination with thrombocytopenia have recently been reported within 4 to 28 days of vaccination with the ChAdOx1 nCov-19 (AstraZeneca/Oxford) and Ad.26.COV2.S (Janssen/Johnson & Johnson) COVID-19 vaccines. An immune-mediated response associated with platelet factor 4/heparin antibodies has been proposed as the underlying pathomechanism. Objective: To determine the frequencies of admission thrombocytopenia, heparin-induced thrombocytopenia, and presence of platelet factor 4/heparin antibodies in patients diagnosed with cerebral venous sinus thrombosis prior to the COVID-19 pandemic. Design, Setting, and Participants: This was a descriptive analysis of a retrospective sample of consecutive patients diagnosed with cerebral venous sinus thrombosis between January 1987 and March 2018 from 7 hospitals participating in the International Cerebral Venous Sinus Thrombosis Consortium from Finland, the Netherlands, Switzerland, Sweden, Mexico, Iran, and Costa Rica. Of 952 patients, 865 with available baseline platelet count were included. In a subset of 93 patients, frozen plasma samples collected during a previous study between September 2009 and February 2016 were analyzed for the presence of platelet factor 4/heparin antibodies. Exposures: Diagnosis of cerebral venous sinus thrombosis. Main Outcomes and Measures: Frequencies of admission thrombocytopenia (platelet count <150 ×103/μL), heparin-induced thrombocytopenia (as diagnosed by the treating physician), and platelet factor 4/heparin IgG antibodies (optical density >0.4, in a subset of patients with previously collected plasma samples). Results: Of 865 patients (median age, 40 years [interquartile range, 29-53 years], 70% women), 73 (8.4%; 95% CI, 6.8%-10.5%) had thrombocytopenia, which was mild (100-149 ×103/μL) in 52 (6.0%), moderate (50-99 ×103/μL) in 17 (2.0%), and severe (<50 ×103/μL) in 4 (0.5%). Heparin-induced thrombocytopenia with platelet factor 4/heparin antibodies was diagnosed in a single patient (0.1%; 95% CI, <0.1%-0.7%). Of the convenience sample of 93 patients with cerebral venous sinus thrombosis included in the laboratory analysis, 8 (9%) had thrombocytopenia, and none (95% CI, 0%-4%) had platelet factor 4/heparin antibodies. Conclusions and Relevance: In patients with cerebral venous sinus thrombosis prior to the COVID-19 pandemic, baseline thrombocytopenia was uncommon, and heparin-induced thrombocytopenia and platelet factor 4/heparin antibodies were rare. These findings may inform investigations of the possible association between the ChAdOx1 nCoV-19 and Ad26.COV2.S COVID-19 vaccines and cerebral venous sinus thrombosis with thrombocytopenia.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu