Krzywicka, KatarzynaKatarzynaKrzywickaAguiar de Sousa, DianaDianaAguiar de SousaCordonnier, CharlotteCharlotteCordonnierBode, Felix JFelix JBodeField, Thalia SThalia SFieldMichalski, DominikDominikMichalskiPelz, JohannJohannPelzSkjelland, MonaMonaSkjellandWiedmann, MarkusMarkusWiedmannZimmermann, JulianJulianZimmermannWittstock, MatthiasMatthiasWittstockZanotti, BrunoBrunoZanottiCiccone, AlfonsoAlfonsoCicconeBandettini di Poggio, MonicaMonicaBandettini di PoggioBorhani-Haghighi, AfshinAfshinBorhani-HaghighiChatterton, SophieSophieChattertonAujayeb, AvinashAvinashAujayebDevroye, AnnemieAnnemieDevroyeDizonno, VanessaVanessaDizonnoGeeraerts, ThomasThomasGeeraertsGiammello, FabrizioFabrizioGiammelloGünther, AlbrechtAlbrechtGüntherIchaporia, Nasli RNasli RIchaporiaKleinig, TimothyTimothyKleinigKristoffersen, Espen SEspen SKristoffersenLemmens, RobinRobinLemmensDe Maistre, EmmanuelEmmanuelDe MaistreMirzaasgari, ZahraZahraMirzaasgariPayen, Jean-FrancoisJean-FrancoisPayenPutaala, JukkaJukkaPutaalaPetruzzellis, MarcoMarcoPetruzzellisRaposo, NicolasNicolasRaposoSadeghi-Hokmabadi, ElyarElyarSadeghi-HokmabadiSchoenenberger, SilviaSilviaSchoenenbergerUmaiorubahan, MeenakshisundaramMeenakshisundaramUmaiorubahanSylaja, P NP NSylajavan de Munckhof, AnitaAnitavan de MunckhofSánchez van Kammen, MayteMayteSánchez van KammenLindgren, ErikErikLindgrenJood, KatarinaKatarinaJoodScutelnic, AdrianAdrianScutelnicHeldner, Mirjam RachelMirjam RachelHeldner0000-0002-3594-2159Poli, SvenSvenPoliKruip, Marieke J H AMarieke J H AKruipArauz, AntonioAntonioArauzConforto, Adriana BAdriana BConfortoAaron, SanjithSanjithAaronMiddeldorp, SaskiaSaskiaMiddeldorpTatlisumak, TurgutTurgutTatlisumakArnold, MarcelMarcelArnoldCoutinho, Jonathan MJonathan MCoutinhoFerro, José MJosé MFerro2024-10-152024-10-152023-05https://boris-portal.unibe.ch/handle/20.500.12422/121520BACKGROUND Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after SARS-CoV-2 vaccination. CVST-VITT patients often present with large intracerebral hemorrhages and a high proportion undergoes decompressive surgery. We describe clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery, and explore predictors of in-hospital mortality in these patients. METHODS We used data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022. We included definite, probable and possible VITT cases, as defined by Pavord et al. RESULTS: Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p<0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found among patients with preoperative coma (17/18, 94% vs 4/14, 29% in the non-comatose; p<0.001), and bilaterally absent pupillary reflexes (7/7, 100%, vs 6/9, 67% with unilaterally reactive pupil, and 4/11, 36%, with bilateral reactive pupils; p=0.023). Postoperative imaging revealed worsening of index hemorrhagic lesion in 19 (70%) patients and new hemorrhagic lesions in 16 (59%) patients. At median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent. CONCLUSIONS Almost two thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.enCOVID-19 vaccinations brain death cerebral venous thrombosis coma surgery600 - Technology::610 - Medicine & healtharticle10.48350/1786773677301410.1111/ene.15735