Association of cerebral venous thrombosis with recent COVID-19 vaccination: case-crossover study using ascertainment through neuroimaging in Scotland
Open Access
- 20 December 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 21 (1), 1-9
- https://doi.org/10.1186/s12879-021-06960-5
Abstract
To investigate the association of primary acute cerebral venous thrombosis (CVT) with COVID-19 vaccination through complete ascertainment of all diagnosed CVT in the population of Scotland. Case-crossover study comparing cases of CVT recently exposed to vaccination (1–14 days after vaccination) with cases less recently exposed. Cases in Scotland from 1 December 2020 were ascertained through neuroimaging studies up to 17 May 2021 and diagnostic coding of hospital discharges up to 28 April 2021, linked to national vaccination records. The main outcome measure was primary acute CVT. Of 50 primary acute CVT cases, 29 were ascertained only from neuroimaging studies, 2 were ascertained only from hospital discharges, and 19 were ascertained from both sources. Of these 50 cases, 14 had received the Astra-Zeneca ChAdOx1 vaccine and 3 the Pfizer BNT162b2 vaccine. The incidence of CVT per million doses in the first 14 days after vaccination was 2.2 (95% credible interval 0.9 to 4.1) for ChAdOx1 and 1 (95% credible interval 0.1 to 2.9) for BNT162b2. The rate ratio for CVT associated with exposure to ChAdOx1 in the first 14 days compared with exposure 15-84 days after vaccination was 3.2 (95% credible interval 1.1 to 9.5). These findings support a causal association between CVT and the AstraZeneca vaccine. The absolute risk of post-vaccination CVT in this population-wide study in Scotland was lower than has been reported for populations in Scandinavia and Germany; the explanation for this is not clear.This publication has 16 references indexed in Scilit:
- US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021JAMA, 2021
- Arterial events, venous thromboembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort studyBMJ, 2021
- Process-related impurities in the ChAdOx1 nCov-19 vaccinePublished by Research Square Platform LLC ,2021
- COVID-19 vaccine-associated cerebral venous thrombosis in GermanyPublished by Cold Spring Harbor Laboratory ,2021
- European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of NeurologyEuropean Journal of Neurology, 2017
- Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously ThoughtStroke, 2016
- Diagnosis and Management of Cerebral Venous ThrombosisStroke, 2011
- Should We Use a Case-Crossover Design?Annual Review of Public Health, 2000