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. 2021 Sep:39:101061.
doi: 10.1016/j.eclinm.2021.101061. Epub 2021 Jul 31.

Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases

Maxime Taquet  1   2 , Masud Husain  3   4 , John R Geddes  1   2 , Sierra Luciano  5 , Paul J Harrison  1   2
Affiliations

Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases

Maxime Taquet et al. EClinicalMedicine. 2021 Sep.

Abstract

Background: There are concerns about a link between the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines against COVID-19 and cerebral venous thrombosis (CVT) and other thrombotic events. One key missing component of the risk-benefit analysis of using such vaccines is the risk of these severe thrombotic events following COVID-19.

Methods: Using a retrospective cohort study based on electronic health records primarily in the USA, the absolute risks of CVT and portal vein thrombosis (PVT) in the two weeks following a diagnosis of COVID-19 (made between January 20, 2020 and March 25, 2021) were calculated. The risks were compared to cohorts of patients with influenza (diagnosed within the same period) and people receiving an mRNA vaccine (i.e. not the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines) against COVID-19 (matched for demographics and the main risk factors for CVT and PVT).

Findings: A total of 537,913 patients with a COVID-19 diagnosis were included. The incidence of CVT in the two weeks after a COVID-19 diagnosis was 42.8 per million people (95% CI 28.5-64.2). This was significantly higher than in a matched cohort of people who received an mRNA vaccine (RR = 6.33, 95% CI 1.87-21.40, P = 0.00014) and patients with influenza (RR = 2.67, 95% CI 1.04-6.81, P = 0.031). The incidence of PVT after COVID-19 diagnosis was 392.3 per million people (95% CI 342.8-448.9). This was significantly higher than in a matched cohort of people who received an mRNA vaccine (RR=4.46, 95% CI 3.12-6.37, P < 0.0001) and patients with influenza (RR=1.43, 95% CI 1.10-1.88, P = 0.0094).

Keywords: COVID-19; Cerebral venous sinus thrombosis; Electronic health records; Portal vein thrombosis; SARS-CoV-2.

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Conflict of interest statement

SL is an employee of TriNetX. MH reports a Wellcome Trust Principal Research Fellowship. All other authors declare: no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig. 1
Incidence of CVT and PVT per million patients as a function of the time since diagnosis of COVID-19, from the first 2 weeks post diagnosis to the 5th and 6th week post diagnosis. The height of the bars represent absolute risks while the error bars represent 95% confidence intervals.
Fig 2
Fig. 2
Relative risk of CVT and PVT after a diagnosis of COVID-19 compared to matched cohorts of people receiving an mRNA vaccine (left) or with a diagnosis of influenza (right). Horizontal lines and numbers in brackets represent the 95% confidence intervals.
See this image and copyright information in PMC

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