Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review

Introduction: COVID-19 vaccines became available after being carefully monitored in clinical trials with safety and efficacy on the human body. However, a few recipients developed unusual side effects, including cerebral venous sinus thrombosis (CVST). We aim to systematically review the baseline features, clinical characteristics, treatment, and outcomes in patients developing CVST post-COVID-19 vaccination. Methods: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) 2020 guideline. Investigators independently searched PubMed, Embase, and Google Scholar for English language articles published from inception up until September 10, 2021, reporting the incidence of CVST post-COVID-19 vaccines. We analyzed CVST patients' baseline data, type of vaccines, clinical findings, treatment, and outcomes. Our systematic review process yielded patient-level data. Result: The final analysis included 25 studies that identified 80 patients who developed CVST after the COVID-19 vaccination. Of the 80 CVST cases, 31 (39.24%) patients died. There was no significant relationship between mortality and age (P = .733), sex (P = .095), vaccine type (P = .798), platelet count (P = .93), and comorbidities such as hypertension (P = .734) and diabetes mellitus (P = .758). However, mortality was associated with the duration of onset of CVST symptoms after vaccination (P = .022). Patients with CVST post-COVID-19 vaccination were more likely to survive if treated with an anticoagulant (P = .039). Patients who developed intracranial hemorrhage (P = .012) or thrombosis in the cortical vein (P = .021) were more likely to die. Conclusion: COVID-19 vaccine-associated CVST is associated with high mortality rate. Timely diagnosis and management can be lifesaving for patients.

Automated summary

This study systematically reviewed the characteristics, clinical findings, treatment, and outcomes of patients developing cerebral venous sinus thrombosis (CVST) post-COVID-19 vaccination. The analysis included 80 CVST cases, with a mortality rate of 39.24%. There was no significant relationship between mortality and age, sex, vaccine type, platelet count, and comorbidities such as hypertension and diabetes mellitus. However, mortality was associated with the duration of onset of CVST symptoms after vaccination. Patients with CVST post-COVID-19 vaccination were more likely to survive if treated with an anticoagulant. Patients who developed intracranial hemorrhage or thrombosis in the cortical vein were more likely to die.