COVID-19 Vaccine-Associated Cerebral Venous Thrombosis in Germany

Ann Neurol. 2021 Oct;90(4):627-639. doi: 10.1002/ana.26172. Epub 2021 Aug 23.

Abstract

Objective: We aimed to estimate the incidence of cerebral sinus and venous thrombosis (CVT) within 1 month from first dose administration and the frequency of vaccine-induced immune thrombotic thrombocytopenia (VITT) as the underlying mechanism after vaccination with BNT162b2, ChAdOx1, and mRNA-1273, in Germany.

Methods: A web-based questionnaire was e-mailed to all departments of neurology. We requested a report of cases of CVT occurring within 1 month of a COVID-19 vaccination. Other cerebral events could also be reported. Incidence rates of CVT were calculated by using official statistics of 9 German states.

Results: A total of 45 CVT cases were reported. In addition, 9 primary ischemic strokes, 4 primary intracerebral hemorrhages, and 4 other neurological events were recorded. Of the CVT patients, 35 (77.8%) were female, and 36 (80.0%) were younger than 60 years. Fifty-three events were observed after vaccination with ChAdOx1 (85.5%), 9 after BNT162b2 (14.5%) vaccination, and none after mRNA-1273 vaccination. After 7,126,434 first vaccine doses, the incidence rate of CVT within 1 month from first dose administration was 0.55 (95% confidence interval [CI] = 0.38-0.78) per 100,000 person-months (which corresponds to a risk of CVT within the first 31 days of 0.55 per 100,000 individuals) for all vaccines and 1.52 (95% CI = 1.00-2.21) for ChAdOx1 (after 2,320,535 ChAdOx1 first doses). The adjusted incidence rate ratio was 9.68 (95% CI = 3.46-34.98) for ChAdOx1 compared to mRNA-based vaccines and 3.14 (95% CI = 1.22-10.65) for females compared to non-females. In 26 of 45 patients with CVT (57.8%), VITT was graded highly probable.

Interpretation: Given an incidence of 0.02 to 0.15 per 100,000 person-months for CVT in the general population, these findings point toward a higher risk for CVT after ChAdOx1 vaccination, especially for women. ANN NEUROL 2021;90:627-639.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • BNT162 Vaccine
  • COVID-19 Vaccines / adverse effects*
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / etiology
  • ChAdOx1 nCoV-19
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Intracranial Thrombosis / epidemiology
  • Intracranial Thrombosis / etiology*
  • Ischemic Stroke / epidemiology
  • Ischemic Stroke / etiology
  • Male
  • Middle Aged
  • Sex Factors
  • Surveys and Questionnaires
  • Venous Thrombosis / epidemiology
  • Venous Thrombosis / etiology*
  • Young Adult

Substances

  • COVID-19 Vaccines
  • ChAdOx1 nCoV-19
  • BNT162 Vaccine