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. |