Sara Aghabaklou, S. Razavi, Pegah Mohammadi, S. Gholamin, A. Mowla
{"title":"COVID-19腺病毒载体疫苗后的脑凝血并发症:系统综述","authors":"Sara Aghabaklou, S. Razavi, Pegah Mohammadi, S. Gholamin, A. Mowla","doi":"10.14740/jnr700","DOIUrl":null,"url":null,"abstract":"Emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak identified in late 2019 in Wuhan, China, was declared a pandemic in March 2020. High fatality rate in afflicted patients prompted scientists and physicians to develop various vaccines against the virus. While administration of millions of doses of the adenoviral vector vaccines (e.g., Oxford-AstraZeneca (ChAdOx1 nCoV-19) and Janssen/Johnson & Johnson (Ad26.COV2. S)) has helped control the disease, numerous cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia have been reported in vaccinated individuals. In this article, we aim to review the cases reported thus far and further discuss the association between the vaccine administration and subsequent cerebral thromboembolic events. Our study was performed and reported based on the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Google Scholar and Norris Medical Library databases were searched using the following terms: coronavirus disease 2019 (COVID-19) vaccines (“AstraZeneca” or “AZD1222 COVID vaccine” or “ChAdOx1 nCoV-19 COVID-19 vaccine” or “Janssen” or “Johnson & Johnson COVID vaccine” or “Ad26.COV2 COVID vaccine”), coagulopathy (“cerebral venous sinus thrombosis (CVST)” and “vaccine-induced immune thrombotic thrombocytopenia (VITT)” or “cerebral venous thrombosis (CVT)”) and thrombocytopenia. All the relevant studies within the English literature up to August 1, 2021, were included. Fourteen most recent articles reporting on 66 patients with CVST and VITT after adenoviral vector vaccination were reviewed by two independent authors. Age of the patients ranged from 18 to 60 years. The majority of cases were women (43 females versus 14 males). Platelet count was between 5 and 127 × 109/L. Above-normal D-dimer was found in 86% of the patients. A total of 68% of the patients had positive platelet factor 4 IgG assay in the absence of prior exposure to heparin. Among CVST cases following COVID vaccination, 44% succumbed to death. Early diagnosis and treatment of CVST plays a fundamental role in decreasing morbidity and mortality. Health care professional should be familiar with this rare complication post vaccination against COVID-19. 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While administration of millions of doses of the adenoviral vector vaccines (e.g., Oxford-AstraZeneca (ChAdOx1 nCoV-19) and Janssen/Johnson & Johnson (Ad26.COV2. S)) has helped control the disease, numerous cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia have been reported in vaccinated individuals. In this article, we aim to review the cases reported thus far and further discuss the association between the vaccine administration and subsequent cerebral thromboembolic events. Our study was performed and reported based on the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Google Scholar and Norris Medical Library databases were searched using the following terms: coronavirus disease 2019 (COVID-19) vaccines (“AstraZeneca” or “AZD1222 COVID vaccine” or “ChAdOx1 nCoV-19 COVID-19 vaccine” or “Janssen” or “Johnson & Johnson COVID vaccine” or “Ad26.COV2 COVID vaccine”), coagulopathy (“cerebral venous sinus thrombosis (CVST)” and “vaccine-induced immune thrombotic thrombocytopenia (VITT)” or “cerebral venous thrombosis (CVT)”) and thrombocytopenia. All the relevant studies within the English literature up to August 1, 2021, were included. Fourteen most recent articles reporting on 66 patients with CVST and VITT after adenoviral vector vaccination were reviewed by two independent authors. Age of the patients ranged from 18 to 60 years. The majority of cases were women (43 females versus 14 males). Platelet count was between 5 and 127 × 109/L. Above-normal D-dimer was found in 86% of the patients. A total of 68% of the patients had positive platelet factor 4 IgG assay in the absence of prior exposure to heparin. Among CVST cases following COVID vaccination, 44% succumbed to death. Early diagnosis and treatment of CVST plays a fundamental role in decreasing morbidity and mortality. Health care professional should be familiar with this rare complication post vaccination against COVID-19. 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引用次数: 7
摘要
2019年底在中国武汉发现的新型冠状病毒——严重急性呼吸综合征2型(SARS-CoV-2)疫情,于2020年3月被宣布为大流行。患者的高致死率促使科学家和医生开发各种针对该病毒的疫苗。同时施用数百万剂腺病毒载体疫苗(例如牛津-阿斯利康(ChAdOx1 nCoV-19)和杨森/强生(Ad26.COV2))。S))有助于控制疾病,在接种疫苗的个体中报告了许多脑静脉窦血栓形成(CVST)伴血小板减少的病例。在本文中,我们旨在回顾迄今为止报道的病例,并进一步讨论疫苗接种与随后的脑血栓栓塞事件之间的关系。我们的研究是根据系统评价和荟萃分析首选报告项目(PRISMA)中概述的指南进行和报告的。PubMed、谷歌Scholar和Norris Medical Library数据库使用以下术语进行检索:2019冠状病毒病(COVID-19)疫苗(“AstraZeneca”或“AZD1222 COVID疫苗”或“ChAdOx1 nCoV-19 COVID疫苗”或“Janssen”或“Johnson & Johnson COVID疫苗”或“Ad26”)。COV2 COVID疫苗”)、凝血功能障碍(“脑静脉窦血栓形成(CVST)”和“疫苗诱导的免疫性血栓性血小板减少(VITT)”或“脑静脉血栓形成(CVT)”)和血小板减少症。纳入截至2021年8月1日的所有英国文献中的相关研究。两位独立作者对最近报道66例腺病毒载体疫苗接种后CVST和VITT患者的14篇文章进行了综述。患者年龄18 ~ 60岁。大多数病例为女性(43名女性对14名男性)。血小板计数在5 ~ 127 × 109/L。86%的患者发现d -二聚体高于正常水平。在没有肝素暴露的情况下,共有68%的患者血小板因子4 IgG检测呈阳性。在COVID疫苗接种后的CVST病例中,44%死于死亡。早期诊断和治疗CVST对降低发病率和死亡率具有重要作用。卫生保健专业人员应该熟悉这种罕见的COVID-19疫苗接种后并发症。鉴于COVID-19疫苗后CVST的罕见性,疫苗接种的好处超过了潜在的危害。
Cerebral Coagulation Complications Following COVID-19 Adenoviral Vector Vaccines: A Systematic Review
Emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak identified in late 2019 in Wuhan, China, was declared a pandemic in March 2020. High fatality rate in afflicted patients prompted scientists and physicians to develop various vaccines against the virus. While administration of millions of doses of the adenoviral vector vaccines (e.g., Oxford-AstraZeneca (ChAdOx1 nCoV-19) and Janssen/Johnson & Johnson (Ad26.COV2. S)) has helped control the disease, numerous cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia have been reported in vaccinated individuals. In this article, we aim to review the cases reported thus far and further discuss the association between the vaccine administration and subsequent cerebral thromboembolic events. Our study was performed and reported based on the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Google Scholar and Norris Medical Library databases were searched using the following terms: coronavirus disease 2019 (COVID-19) vaccines (“AstraZeneca” or “AZD1222 COVID vaccine” or “ChAdOx1 nCoV-19 COVID-19 vaccine” or “Janssen” or “Johnson & Johnson COVID vaccine” or “Ad26.COV2 COVID vaccine”), coagulopathy (“cerebral venous sinus thrombosis (CVST)” and “vaccine-induced immune thrombotic thrombocytopenia (VITT)” or “cerebral venous thrombosis (CVT)”) and thrombocytopenia. All the relevant studies within the English literature up to August 1, 2021, were included. Fourteen most recent articles reporting on 66 patients with CVST and VITT after adenoviral vector vaccination were reviewed by two independent authors. Age of the patients ranged from 18 to 60 years. The majority of cases were women (43 females versus 14 males). Platelet count was between 5 and 127 × 109/L. Above-normal D-dimer was found in 86% of the patients. A total of 68% of the patients had positive platelet factor 4 IgG assay in the absence of prior exposure to heparin. Among CVST cases following COVID vaccination, 44% succumbed to death. Early diagnosis and treatment of CVST plays a fundamental role in decreasing morbidity and mortality. Health care professional should be familiar with this rare complication post vaccination against COVID-19. Given the rarity of CVST after the COVID-19 vaccine, the benefit of vaccination outweighs the potential harm.