Acute Arterial Ischemic Stroke Following COVID-19 Vaccination
- 4 October 2022
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 99 (14), E1465-E1474
- https://doi.org/10.1212/wnl.0000000000200996
Abstract
Background: Acute arterial-ischemic-stroke (AIS) has been reported as a rare adverse-event following COVID-19-vaccination with mRNA or viral-vector vaccines. However, data are sparse regarding the risk of post-vaccination AIS and its potential association with thrombotic-thrombocytopenia-syndrome (TTS). Methods: A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs), pharmacovigilance registries, registry-based studies, observational cohorts and case-series was performed with the aim to calculate: (1) the pooled proportion of patients presenting with AIS following COVID-19-vaccination; (2) the prevalence of AIS after mRNA and vector-based vaccination; (3) the proportion of TTS among post-vaccination AIS-cases. Patient characteristics were assessed as secondary outcomes. Results: Two RCTs, three cohort and eleven registry-based studies comprising 17,481 AIS-cases among 782,989,363 COVID-19-vaccinations were included in the meta-analysis. The pooled proportion of AIS following exposure to any COVID-19-vaccine type was 4.7 cases per 100,000 vaccinations (95%CI:2.2-8.1; I2=99.9%). The pooled proportion of AIS following mRNA-vaccination (9.2 cases per 100,000 vaccinations; 95%CI: 2.5-19.3; I2=99.9%) did not differ compared to adenovirus-based-vaccination (2.9 cases per 100,000 vaccinations; 95%CI: 0.3-7.8; I2=99.9%). No differences regarding demographics were disclosed between patients with AIS following mRNA- or vector-based vaccination. The pooled proportion of TTS among post-vaccination AIS-cases was 3.1% (95%CI: 0.7-7.2%; I2=78.8%). Conclusions: The pooled proportion of AIS following COVID-19 vaccination is comparable to the prevalence of AIS in the general population and much lower than the AIS prevalence among SARS-CoV-2-infected patients. TTS is very uncommonly reported in patients with AIS following COVID-19 vaccination.This publication has 46 references indexed in Scilit:
- Ischemic Stroke Epidemiology During the COVID-19 PandemicStroke, 2020
- SARS-CoV-2 and Stroke in a New York Healthcare SystemStroke, 2020
- Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017BMC Medicine, 2019
- Influenza and pneumococcal vaccination and risk of stroke or transient ischaemic attack—Matched case control studyVaccine, 2014
- Clinical effectiveness of pneumococcal vaccination against acute myocardial infarction and stroke in people over 60 years: the CAPAMIS study, one-year follow-upBMC Public Health, 2012
- Closing the Gap between Methodologists and End-Users:Ras a Computational Back-EndJournal of Statistical Software, 2012
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- Meta-analysis of Observational Studies in EpidemiologyA Proposal for ReportingJAMA, 2000
- Bias in meta-analysis detected by a simple, graphical testBMJ, 1997
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke, 1993