Author and

Publication year

Study

design

Population, Sample size and Age of participants

Settings/

Strategy

Results and main < findings

Taquet et al. 2021 [15]

Retrospective cohort

-537,913 patients diagnosed with COVID-19

-Male:45.1%

-Mean age = 46.2 years

-Patients with COVID-19 and CVT: 23 (100%)

-Male: 30.4%

-Mean age = 46.5 years

-USA

-Compared with two cohorts of influenza patients and individuals received mRNA vaccine

*The incidence of CVT in the two weeks after a COVID-19 diagnosis was 42.8 per million people

*The incidence of CVT among COVID-19 patients was significantly higher than in a matched cohort of people who received an mRNA vaccine and patients with influenza

*The incidence of PVT after COVID-19 diagnosis was 392.3 per million people; this was significantly higher than in a matched cohort of people who received an mRNA vaccine and patients with influenza

*COVID-19 is associated with a markedly increased incidence of CVT compared to patients with influenza, people who have received BNT162b2 or mRNA-1273 vaccines and compared to the best estimates of the general population incidence. compared to previously reported non-COVID-19

Hameed et

al. 2021

[16]

Multicenter

and multinational

observational study

-20 patients with symptomatic CVT and recent COVID-19

-Male: 70%

-Mean age = 42.4 years

-Ten centers from 4 countries

participated; Egypt, Pakistan,

Singapore, UAE

*Headache (85%) and seizures (65%) were the common presenting symptoms

*CVT was the presenting manifestation in 13 cases (65%), 7 (35%) patients developed CVT while being treated for COVID-19

*Respiratory symptoms were absent in 45% of the patients.

*The most common imaging finding was infarction (65%), followed by hemorrhage (20%).

*The superior sagittal sinus (65%) was the most common site of thrombosis.

*Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels.

*Homocysteine was elevated in half of the tested cases.

*The mortality rate was 20% (4 patients); mortality is high, but functional neurological outcome is good among survivors.

*COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19.

Al-Mufti et al. 2021 [17]

Retrospective multicenter cohort

-13,500 patients with COVID-19

-Male:

-Mean age = 48 years

Six different New York tertiary care centers

*12 patients (%) had imaging-proved CVT

*The incidence of CVT was 8.8 per 10,000 during 3 months

*The incidence of CVT is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually.

*There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36 - 62 years; range, 17 - 95 years).

*1 patient (8%) had a history of thromboembolic disease

*Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging *Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation.

*The mortality rate was 25%.

*Early evidence suggests a higher-than-expected frequency of cerebral

Li et al.

2020 [18]

Retrospecti

ve

observatio

nal

-221 patients with COVID-19

-Male: 59.3%

-Mean age = 53.3

Union

Hospital,

Wuhan,

China

*11 (5%) developed acute ischemic stroke, 1 (0·5%) cerebral venous sinus thrombosis (CVST), and 1 (0.5%) cerebral hemorrhage.

*COVID-19 with new onset of CVD were significantly older (71.6 ± 15.7 years vs 52.1 ± 15.3 years; p<0·05), and more likely to present with severe COVID-19 (84.6% vs. 39.9%, p < 0.01)

*COVID-19 with new onset of CVD were significantly more likely to have cardiovascular risk factors, including hypertension, diabetes, and previous medical history of cerebrovascular disease (all p<0·05).

*COVID-19 with new onset of CVD were more likely to have increased inflammatory response and hypercoagulable state as reflected in C-reaction protein and D-dimer

*Of 11 patients with ischemic stroke, 6 received antiplatelet treatment with Aspirin or Clopidogrel and 3 of them died. The other 5 patients received anticoagulant treatment with Clexane and one of them died.

*The mortality rate was

Mowala et al. 2020 [19]

Multinational

retrospective study

Two groups;

Group one:

-13 patients with CVST and COVID-19

-Male:38.5%

-Mean age = 50.9

Group two (control):

-57 CVST patient without COVID-19

-Male: 33.3%

-Mean age = 36.7

Nine centers in

three countries.

Eleven patients

from seven centers in Iran, one patient from the United States and one patient from Singapore were recruited

*of 13 patients with CVST and COVID-19; Six patients were discharged with good outcomes (mRS ≤ 2) and three patients died in hospital.

*Compared to the control group, the SARS-CoV-2 infected patients were significantly older, had a lower rate of identified CVST risk factors, had more frequent cortical vein involvement, and a non-significant higher rate of in-hospital mortality

*CVST should be considered as potential comorbidity in COVID-19 infected patients presenting with neurological symptoms.

*Compared to non-SARS-CoV-2 infected patients, CVST occurs in older patients, with lower rates of known CVST risk factors and might lead to a poorer outcome in the COVID-19 infected group.

Cavalcanti

et al. 2020 [20]

Case series

-3 patients developed profound neurologic injury secondary to CVT with COVID-19

-Male: 2 (66.66%)

-Mean age = 34 years

USA

*One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins.

*Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2 - 7 days).

*Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavirritonavir.

*All patients had a fatal outcome

*Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19.

*No conclusions can be drawn other than that these cases provide hints as to the accumulating evidence that COVID-19 is a serious contributor to hypercoagulation, increasing the fatality of the disease.

*Heightened awareness of this atypical but potentially treatable complication of the disease.