Johann Otto Pelz, Martin Kenda, Angelika Alonso, Nima Etminan, Matthias Wittstock, Wolf-Dirk Niesen, Johann Lambeck, Erdem Güresir, Johannes Wach, Tim Lampmannn, Rainer Dziewas, Markus Wiedmann, Hauke Schneider, Antonios Bayas, Monika Christ, Annerose Mengel, Sven Poli, Dirk Brämer, Dirk Lindner, Christian Pfrepper, Christian Roth, Farid Salih, Albrecht Günther, Dominik Michalski
- Background
Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome.
Methods
This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS.
Results
Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospitalBackground
Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome.
Methods
This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS.
Results
Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043).
Conclusions
Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients.…
MetadatenAuthor: | Johann Otto Pelz, Martin Kenda, Angelika Alonso, Nima Etminan, Matthias Wittstock, Wolf-Dirk Niesen, Johann Lambeck, Erdem Güresir, Johannes Wach, Tim Lampmannn, Rainer Dziewas, Markus Wiedmann, Hauke Schneider, Antonios Bayas, Monika Christ, Annerose Mengel, Sven Poli, Dirk Brämer, Dirk Lindner, Christian Pfrepper, Christian Roth, Farid Salih, Albrecht Günther, Dominik Michalski |
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URN: | urn:nbn:de:bvb:384-opus4-1093634 |
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Frontdoor URL | https://opus.bibliothek.uni-augsburg.de/opus4/109363 |
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ISSN: | 1541-6933OPAC |
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ISSN: | 1556-0961OPAC |
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Parent Title (English): | Neurocritical Care |
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Publisher: | Springer Science and Business Media LLC |
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Place of publication: | Berlin |
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Type: | Article |
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Language: | English |
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Year of first Publication: | 2024 |
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Publishing Institution: | Universität Augsburg |
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Release Date: | 2023/11/30 |
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Tag: | Critical Care and Intensive Care Medicine; Neurology (clinical) |
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Volume: | 40 |
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First Page: | 621 |
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Last Page: | 632 |
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DOI: | https://doi.org/10.1007/s12028-023-01782-6 |
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Institutes: | Medizinische Fakultät |
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| Medizinische Fakultät / Universitätsklinikum |
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| Medizinische Fakultät / Lehrstuhl für Neurologie |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Licence (German): | CC-BY 4.0: Creative Commons: Namensnennung (mit Print on Demand) |
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